Provider Demographics
NPI:1902529423
Name:DEEB, SERGIO P
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:P
Last Name:DEEB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9031 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1414
Mailing Address - Country:US
Mailing Address - Phone:305-274-6776
Mailing Address - Fax:305-274-9724
Practice Address - Street 1:9031 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1414
Practice Address - Country:US
Practice Address - Phone:305-274-6776
Practice Address - Fax:305-274-9724
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist