MEDICARE: HOSPITALIST OF SOUTH SLORIDA INC

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	207R00000X	Internal Medicine Physician	591266 3	FL

General Provider Information

NPI Number	:	1952449654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPITALIST OF SOUTH SLORIDA INC

Provider Business Mailing Address
First Line	:	11760 SW 40TH ST STE 112
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3589
Country	:	US
Telephone Number	:	305-485-7979
Fax Number	:	305-485-3533

Provider Business Practice Location Address
First Line	:	11760 SW 40TH ST STE 112
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3589
Country	:	US
Telephone Number	:	305-485-7979
Fax Number	:	305-485-3533

Authorized Official
Title or Position	:	C.E.O
Name	:	TOMAS VILLANUEVA
Credential	:	D.O.
Telephone Number	:	305-485-7979

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	08/22/2020

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