Provider Demographics
NPI:1750494373
Name:SOUTH FLORIDA PERINATAL MEDICINE
Entity Type:Organization
Organization Name:SOUTH FLORIDA PERINATAL MEDICINE
Other - Org Name:SFPM
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-669-9521
Mailing Address - Street 1:6200 SUNSET DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4828
Mailing Address - Country:US
Mailing Address - Phone:305-669-9521
Mailing Address - Fax:305-669-9735
Practice Address - Street 1:6200 SUNSET DR
Practice Address - Street 2:SUITE 301
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4828
Practice Address - Country:US
Practice Address - Phone:305-669-9521
Practice Address - Fax:305-669-9735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL547400-2174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34212OtherBC/BS
FL268043200Medicaid
FL34212OtherBC/BS