Provider Demographics
NPI:1144332362
Name:FLORIDA HEALTH SPECIALTY PROVIDERS INC.
Entity type:Organization
Organization Name:FLORIDA HEALTH SPECIALTY PROVIDERS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SERJIO
Authorized Official - Middle Name:OSCAR
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-693-8888
Mailing Address - Street 1:1301 SW 126TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2311
Mailing Address - Country:US
Mailing Address - Phone:305-553-8267
Mailing Address - Fax:
Practice Address - Street 1:7900 NW 27TH AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-4902
Practice Address - Country:US
Practice Address - Phone:305-693-8888
Practice Address - Fax:305-693-8893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC5751OtherSTATE OF FLORIDA
FLHCC5751OtherSTATE OF FLORIDA