Provider Demographics
NPI:1336645936
Name:SABUCEDO NEPHROLOGY GROUP INC
Entity Type:Organization
Organization Name:SABUCEDO NEPHROLOGY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:J
Authorized Official - Last Name:SABUCEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-793-0605
Mailing Address - Street 1:690 W PARK DR APT 208
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5325
Mailing Address - Country:US
Mailing Address - Phone:305-793-0605
Mailing Address - Fax:
Practice Address - Street 1:6140 SW 70TH ST FL 2
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3419
Practice Address - Country:US
Practice Address - Phone:305-793-0605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117297207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty