Provider Demographics
NPI:1336484484
Name:SENIOR MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:SENIOR MEDICAL ASSOCIATES LLC
Other - Org Name:LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:RA
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:N
Authorized Official - Last Name:DE VERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-649-8100
Mailing Address - Street 1:1000 NW 57TH CT STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3292
Mailing Address - Country:US
Mailing Address - Phone:305-649-8100
Mailing Address - Fax:954-580-8942
Practice Address - Street 1:1855 N CORPORATE LAKES BLVD STE 1
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3274
Practice Address - Country:US
Practice Address - Phone:954-659-9690
Practice Address - Fax:954-659-9694
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENIOR MEDICAL ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-30
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty