Provider Demographics
NPI:1093026981
Name:SOUTH FLORIDA SURGICAL SERVICES LLC
Entity Type:Organization
Organization Name:SOUTH FLORIDA SURGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:RAUL
Authorized Official - Last Name:VALLADARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-375-1055
Mailing Address - Street 1:PO BOX 451050
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33245-1050
Mailing Address - Country:US
Mailing Address - Phone:786-375-1055
Mailing Address - Fax:786-245-7650
Practice Address - Street 1:351 NW 42ND AVE STE 409
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5689
Practice Address - Country:US
Practice Address - Phone:305-631-5355
Practice Address - Fax:305-631-5354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91049208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH63071Medicare UPIN