Provider Demographics
NPI:1053548537
Name:SOUTH FLORIDA FAMILY HEALTH AND RESEARCH CENTERS, LLC.
Entity type:Organization
Organization Name:SOUTH FLORIDA FAMILY HEALTH AND RESEARCH CENTERS, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-387-0081
Mailing Address - Street 1:13500 SW 88TH ST STE 175
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1528
Mailing Address - Country:US
Mailing Address - Phone:305-387-0081
Mailing Address - Fax:305-387-0053
Practice Address - Street 1:13500 SW 88TH STR
Practice Address - Street 2:SUITE 175
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1528
Practice Address - Country:US
Practice Address - Phone:305-387-0051
Practice Address - Fax:305-387-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8585261Q00000X, 261QH0100X, 261QM1300X, 261QP2300X, 261QR1100X, 261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health