Provider Demographics
NPI:1497204994
Name:SOUTH FLORIDA CARDIOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:SOUTH FLORIDA CARDIOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-256-9657
Mailing Address - Street 1:1700 79TH STREET CSWY STE 120
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4197
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5480 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-4539
Practice Address - Country:US
Practice Address - Phone:954-210-9770
Practice Address - Fax:954-210-9771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-25
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77166EOtherMEDICARE
FL77166EOtherMEDICARE