| Sunsouth Health Centers South Florida, Llc | |
|
1901 Nw 17th Ave Miami FL 33125-1513 | |
| (305) 925-0009 | |
| (305) 697-0009 |
| Full Name | Sunsouth Health Centers South Florida, Llc |
|---|---|
| Speciality | General Practice |
| Location | 1901 Nw 17th Ave, Miami, Florida |
| Authorized Official Name and Position | Carlos Arias (CEO) |
| Authorized Official Contact | 4075581872 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sunsouth Health Centers South Florida, Llc 14255 Sw 42nd St Miami FL 33175-6408 Ph: (305) 306-3400 | Sunsouth Health Centers South Florida, Llc 1901 Nw 17th Ave Miami FL 33125-1513 Ph: (305) 925-0009 |
| NPI Number | 1114585643 |
|---|---|
| Provider Enumeration Date | 05/30/2019 |
| Last Update Date | 05/05/2021 |
| Medicare PECOS PAC ID | 2365888955 |
|---|---|
| Medicare Enrollment ID | O20240305004496 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114585643 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Yaolen Bolanos |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942402045 PECOS PAC ID: 1850434788 Enrollment ID: I20100201000487 |
| Provider Name | Naji Nouneh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699708222 PECOS PAC ID: 1052395787 Enrollment ID: I20130501000353 |
| Provider Name | Aurelia B Leblanc Nunez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1477049153 PECOS PAC ID: 0648515890 Enrollment ID: I20181217003139 |
| Provider Name | Jorge Manuel Gomez Vizcarra |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1366911471 PECOS PAC ID: 0244635662 Enrollment ID: I20210824001388 |
| Provider Name | Felipe Diaz Rizo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659974459 PECOS PAC ID: 1355731506 Enrollment ID: I20211202002740 |
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