Provider Demographics
NPI:1477083269
Name:NEPHROLOGY SPECIALISTS OF FLORIDA, LLC.
Entity Type:Organization
Organization Name:NEPHROLOGY SPECIALISTS OF FLORIDA, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARDONA-GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-407-9900
Mailing Address - Street 1:PO BOX 652256
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33265-2256
Mailing Address - Country:US
Mailing Address - Phone:305-407-9900
Mailing Address - Fax:888-981-2863
Practice Address - Street 1:747 PONCE DE LEON BLVD STE 605
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2074
Practice Address - Country:US
Practice Address - Phone:305-407-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGI3222ZOtherMEDICARE
FL005961600Medicaid