Provider Demographics
NPI:1619086410
Name:MEDICAL GROUP AT SOUTH MIAMI INC
Entity Type:Organization
Organization Name:MEDICAL GROUP AT SOUTH MIAMI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:OCTAVIO
Authorized Official - Last Name:ROCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-663-0710
Mailing Address - Street 1:6701 SUNSET DR
Mailing Address - Street 2:212
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4529
Mailing Address - Country:US
Mailing Address - Phone:305-663-0710
Mailing Address - Fax:305-665-3051
Practice Address - Street 1:6701 SUNSET DR
Practice Address - Street 2:212
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4529
Practice Address - Country:US
Practice Address - Phone:305-663-0710
Practice Address - Fax:305-665-3051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62402174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268288500Medicaid
FL268288500Medicaid
FLK1100Medicare PIN