Basic Information
| Provider Information | |||||||||
| NPI: | 1992391072 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICAN CARE OF SOUTH FLORIDA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12171 SW 268TH ST | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330328001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052780200 | ||||||||
| FaxNumber: | 3058514110 | ||||||||
| Practice Location | |||||||||
| Address1: | 20911 NW 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331692105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862970070 | ||||||||
| FaxNumber: | 7862650974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2020 | ||||||||
| LastUpdateDate: | 01/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | BOUZA | ||||||||
| AuthorizedOfficialFirstName: | AGUEDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER SERVICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3052780200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.