| Sacred Heart Medical Office Pa | |
|
17901 Nw 5th St Suite 205 Pembroke Pines FL 33029-2810 | |
| (954) 392-0333 | |
| (954) 392-0393 |
| Full Name | Sacred Heart Medical Office Pa |
|---|---|
| Speciality | Clinic/center |
| Location | 17901 Nw 5th St, Pembroke Pines, Florida |
| Authorized Official Name and Position | Yvelice A Villaman-bencosme (OWNER) |
| Authorized Official Contact | 9543920333 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sacred Heart Medical Office Pa 17901 Nw 5th St Suite 205 Pembroke Pines FL 33029-2810 Ph: (954) 392-0333 | Sacred Heart Medical Office Pa 17901 Nw 5th St Suite 205 Pembroke Pines FL 33029-2810 Ph: (954) 392-0333 |
| NPI Number | 1609199017 |
|---|---|
| Provider Enumeration Date | 03/12/2010 |
| Last Update Date | 03/12/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609199017 | NPI | - | NPPES |
| 001454700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | ME64482 (Florida) | Primary |
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