Basic Information
| Provider Information | |||||||||
| NPI: | 1033475900 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCIBERRAS INTERNAL MEDICINE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3801 S OCEAN DR | ||||||||
| Address2: | 5F | ||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330192925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185102561 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 S FEDERAL HWY | ||||||||
| Address2: | |||||||||
| City: | DANIA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330043622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543999941 | ||||||||
| FaxNumber: | 9543999987 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2012 | ||||||||
| LastUpdateDate: | 05/07/2012 | ||||||||
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| AuthorizedOfficialLastName: | SCIBERRAS | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9543999941 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | OS 9687 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 279454300 | 05 | FL | MEDICAID |