Provider Demographics
NPI:1639119498
Name:CARDIOVASCULAR ASSOCIATES OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VERGARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-667-7451
Mailing Address - Street 1:4685 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2132
Mailing Address - Country:US
Mailing Address - Phone:305-661-2534
Mailing Address - Fax:305-667-7451
Practice Address - Street 1:4685 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2132
Practice Address - Country:US
Practice Address - Phone:305-661-2534
Practice Address - Fax:305-667-7451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 16592207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97221Medicare ID - Type Unspecified