Medical Group At South Miami INC
Specialist in South Miami, FL. Organization (NPI-2).
NPI number1619086410
StatusActive
Last updated in NPPESJun 24, 2011
Details
- NPI
- 1619086410
- Entity type
- Organization (NPI-2)
- Legal business name
- Medical Group At South Miami INC
- Organization subpart
- No
- Enumeration date
- Aug 29, 2006
- Last updated
- Jun 24, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | me62402 | FL | Yes |
Practice location
6701 Sunset Dr212
South Miami, FL 33143-4529
Phone 305-663-0710 · Fax 305-665-3051
Mailing address
6701 Sunset Dr212
South Miami, FL 33143-4529
Phone 305-663-0710 · Fax 305-665-3051
Authorized official
Alejandro Octavio Roca
President Of Corporation
3056630710
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