| South Florida Sports And Preventive Medicine Inc | |
|
14601 Sw 29th St Ste 109 Miramar FL 33027-4715 | |
| (954) 800-1991 | |
| (808) 731-8348 |
| Full Name | South Florida Sports And Preventive Medicine Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 14601 Sw 29th St Ste 109, Miramar, Florida |
| Authorized Official Name and Position | Sergio Guiteau (PRESIDENT) |
| Authorized Official Contact | 5168490072 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Florida Sports And Preventive Medicine Inc 14601 Sw 29th St Ste 109 Miramar FL 33027-4715 Ph: (954) 800-1991 | South Florida Sports And Preventive Medicine Inc 14601 Sw 29th St Ste 109 Miramar FL 33027-4715 Ph: (954) 800-1991 |
| NPI Number | 1790246148 |
|---|---|
| Provider Enumeration Date | 03/28/2019 |
| Last Update Date | 07/11/2023 |
| Medicare PECOS PAC ID | 6507198504 |
|---|---|
| Medicare Enrollment ID | O20191024000310 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790246148 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 261QM2500X | Clinic/center - Medical Specialty | (* (Not Available)) | Primary |
| Provider Name | Biarda Villaverde |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982038444 PECOS PAC ID: 6901036979 Enrollment ID: I20140313001533 |
| Provider Name | Sergio G Guiteau |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720379753 PECOS PAC ID: 6901171008 Enrollment ID: I20170928002824 |
| Provider Name | Sandra M Guiteau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154044006 PECOS PAC ID: 6901261593 Enrollment ID: I20230504000885 |
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