# SPORT MEDICAL CENTER CORP

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

## Provider details

- **NPI number:** 1235421876
- **Authorized official:** HISELA CASTRO (PRESIDENT)
- **Authorized official phone:** (305) 526-1599

## Contact information

- **Practice address:** 6501 NW 36TH ST, STE 302, VIRGINIA GARDENS, FL 33166-6959
- **Practice address phone:** (305) 526-1599
- **Practice address fax:** (305) 526-1699
- **Mailing address:** 6501 NW 36TH ST, STE 302, VIRGINIA GARDENS, FL 33166-6959
- **Mailing address phone:** (305) 526-1599
- **Mailing address fax:** (305) 526-1699

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | HCC9156 | FL | Yes |

## Other

- **Enumeration date:** 05/13/2011
- **Last updated:** 05/13/2011