1982626024 NPI number — SRCX ENTERPRISES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982626024 NPI number — SRCX ENTERPRISES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SRCX ENTERPRISES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982626024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16300 NE 19TH AVE
Provider Second Line Business Mailing Address:
SUITE 232
Provider Business Mailing Address City Name:
NORTH MIAMI BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33162-4883
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-940-2796
Provider Business Mailing Address Fax Number:
305-940-2798

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16300 NE 19TH AVE
Provider Second Line Business Practice Location Address:
SUITE 232
Provider Business Practice Location Address City Name:
NORTH MIAMI BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33162-4883
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-940-2796
Provider Business Practice Location Address Fax Number:
305-940-2798
Provider Enumeration Date:
07/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CASTILLO
Authorized Official First Name:
SILVIO
Authorized Official Middle Name:
RAFAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-940-2796

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)