Provider Demographics
NPI:1790246148
Name:SOUTH FLORIDA SPORTS AND PREVENTIVE MEDICINE INC
Entity Type:Organization
Organization Name:SOUTH FLORIDA SPORTS AND PREVENTIVE MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUITEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-849-0072
Mailing Address - Street 1:14601 SW 29TH ST STE 109
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4715
Mailing Address - Country:US
Mailing Address - Phone:954-800-1991
Mailing Address - Fax:
Practice Address - Street 1:14601 SW 29TH ST STE 109
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4715
Practice Address - Country:US
Practice Address - Phone:954-800-1991
Practice Address - Fax:808-731-8348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care