Provider Demographics
NPI:1629694203
Name:OAKS MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:OAKS MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:SOBREIRA
Authorized Official - Last Name:DE CARVALHO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:305-299-6519
Mailing Address - Street 1:2854 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020
Mailing Address - Country:US
Mailing Address - Phone:305-299-6519
Mailing Address - Fax:954-206-5595
Practice Address - Street 1:2854 JACKSON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020
Practice Address - Country:US
Practice Address - Phone:305-299-6519
Practice Address - Fax:954-206-5595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty