Organization
SACRED HEART MEDICAL OFFICE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YVELICE A VILLAMAN-BENCOSME MD (OWNER)
(954) 392-0333
Entity
Organization
Contact information
Practice address
17901 NW 5TH ST, SUITE 205, PEMBROKE PINES, FL 33029-2810
(954) 392-0333
(954) 392-0393
Mailing address
17901 NW 5TH ST, SUITE 205, PEMBROKE PINES, FL 33029-2810
(954) 392-0333
(954) 392-0393
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
ME64482
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001454700
—
FL
Enumeration date
03/12/2010
Last updated
03/12/2010
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