| Supra Medical Group | |
|
201 Nw 70th Ave Ste A Plantation FL 33317-2369 | |
| (305) 485-1532 | |
| (305) 485-1534 |
| Full Name | Supra Medical Group |
|---|---|
| Speciality | Clinic/center |
| Location | 201 Nw 70th Ave Ste A, Plantation, Florida |
| Authorized Official Name and Position | Rafael Sosa (OWNER) |
| Authorized Official Contact | 3054851532 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Supra Medical Group 201 Nw 70th Ave Ste A Plantation FL 33317-2369 Ph: (305) 485-1532 | Supra Medical Group 201 Nw 70th Ave Ste A Plantation FL 33317-2369 Ph: (305) 485-1532 |
| NPI Number | 1285056663 |
|---|---|
| Provider Enumeration Date | 01/20/2014 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285056663 | NPI | - | NPPES |
| HCC10035 | Other | FL | AHCA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (Florida) | Primary |
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