| Supra Medical Group Ii, Llc | |
|
10300 Sw 72nd St Ste 101 Miami FL 33173-3038 | |
| (305) 200-5210 | |
| (305) 200-5780 |
| Full Name | Supra Medical Group Ii, Llc |
|---|---|
| Speciality | Counselor |
| Location | 10300 Sw 72nd St Ste 101, Miami, Florida |
| Authorized Official Name and Position | Kleydson Neves Da Silva (MANAGER) |
| Authorized Official Contact | 7862054515 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Supra Medical Group Ii, Llc 10300 Sunset Dr Ste 101 Miami FL 33173-3038 Ph: () - | Supra Medical Group Ii, Llc 10300 Sw 72nd St Ste 101 Miami FL 33173-3038 Ph: (305) 200-5210 |
| NPI Number | 1033650221 |
|---|---|
| Provider Enumeration Date | 03/20/2017 |
| Last Update Date | 11/30/2022 |
| Certification Date | 11/30/2022 |
| Medicare PECOS PAC ID | 2961805536 |
|---|---|
| Medicare Enrollment ID | O20210721000408 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033650221 | NPI | - | NPPES |
| Provider Name | Fernando Fandino-sende |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1285692293 PECOS PAC ID: 8325070964 Enrollment ID: I20050906000174 |
| Provider Name | Luis M Ramos Gonez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437391687 PECOS PAC ID: 3779732227 Enrollment ID: I20120927000454 |
| Provider Name | Angela Maria Hansen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235685181 PECOS PAC ID: 6002212255 Enrollment ID: I20210914000281 |
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