Provider Demographics
NPI:1508895624
Name:SOUTH FLORIDA NEPHROLOGY PA
Entity Type:Organization
Organization Name:SOUTH FLORIDA NEPHROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-986-9008
Mailing Address - Street 1:1150 N 35TH AVE STE 465
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5467
Mailing Address - Country:US
Mailing Address - Phone:954-986-9008
Mailing Address - Fax:954-986-6646
Practice Address - Street 1:1150 N 35TH AVE STE 465
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5467
Practice Address - Country:US
Practice Address - Phone:954-986-9008
Practice Address - Fax:954-986-6646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH84431Medicare UPIN
FL57632Medicare PIN