Provider Demographics
NPI:1447595194
Name:SAWGRASS HOSPITALIST PA
Entity Type:Organization
Organization Name:SAWGRASS HOSPITALIST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:SEGUNDO
Authorized Official - Last Name:BRICENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-331-0782
Mailing Address - Street 1:3093 NW 126TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-6342
Mailing Address - Country:US
Mailing Address - Phone:610-331-0782
Mailing Address - Fax:954-964-6084
Practice Address - Street 1:3501 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5421
Practice Address - Country:US
Practice Address - Phone:954-987-2000
Practice Address - Fax:954-964-6084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty