# SUN GROVE MEDICAL GROUP PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003746777
- **Authorized official:** JORGE HERNANDEZ CANCIOBELLO MD (OWNER)
- **Authorized official phone:** (787) 565-9062

## Contact information

- **Practice address:** 10339 SW 145TH CT, MIAMI, FL 33186-6946
- **Practice address phone:** (787) 565-9062
- **Mailing address:** PO BOX 960183, MIAMI, FL 33296-0183

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/22/2026
- **Last updated:** 05/22/2026