Organization
SUPRA MEDICAL GROUP II, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KLEYDSON DA SILVA (CEO)
(305) 200-5210
Entity
Organization
Contact information
Practice address
10300 SW 72ND ST STE 101, MIAMI, FL 33173-3038
(305) 200-5210
(305) 200-5780
Mailing address
10300 SW 72ND ST STE 101, MIAMI, FL 33173-3038
(305) 200-5210
(305) 200-5780
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
11/01/2021
Last updated
11/01/2021
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