MEDICARE: SOUTH FLORIDA SURGICAL ALLIANCE CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician

General Provider Information

NPI Number	:	1801135868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA SURGICAL ALLIANCE CORP

Provider Business Mailing Address
First Line	:	500 S FEDERAL HWY
Second Line	:	SUITE 1292
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33008-6000
Country	:	US
Telephone Number	:	786-252-7990
Fax Number	:	786-472-4596

Provider Business Practice Location Address
First Line	:	500 S FEDERAL HWY
Second Line	:	SUITE 1292
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33008-6000
Country	:	US
Telephone Number	:	786-252-7990
Fax Number	:	786-472-4596

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TONI LYNN VALENCIA
Credential	:
Telephone Number	:	786-252-7990

Provider Enumeration Date	:	02/11/2013
Last Update Date	:	02/11/2013

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