1407424096 NPI number — SLEEP SNORING & SINUS CLINIC OF FLORIDA, LLC

Table of content: (NPI 1407424096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407424096 NPI number — SLEEP SNORING & SINUS CLINIC OF FLORIDA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP SNORING & SINUS CLINIC OF FLORIDA, LLC
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:
1407424096
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1172 S DIXIE HWY, PMB# 452
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAL GABLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33146-2918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-608-0207
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 NW 82ND AVE STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33324-1853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-368-6673
Provider Business Practice Location Address Fax Number:
786-946-2831
Provider Enumeration Date:
06/11/2021

Additional Information

Authorized Official

Authorized Official Last Name:
TORRE
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
305-608-0207

Provider Taxonomy Codes

  • Taxonomy code: 207YS0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110900500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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