Organization
SUPRA MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAFAEL SOSA (OWNER)
(305) 485-1532
Entity
Organization
Contact information
Practice address
201 NW 70TH AVE STE A, PLANTATION, FL 33317-2369
(305) 485-1532
(305) 485-1534
Mailing address
201 NW 70TH AVE STE A, PLANTATION, FL 33317-2369
(305) 485-1532
(305) 485-1534
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HCC10035
AHCA
FL
Enumeration date
01/20/2014
Last updated
07/21/2022
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