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Organization

SURAMED HEALTH CENTER, PA

Active
Other names
SURAMED HEALTH CENTER PA PORT SAINT LUCIE
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ALFONSO J HENRIQUEZ MD (PEDIATRICS)
(772) 204-2909
Entity
Organization

Contact information

Practice address
683 SW PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34953-1998
(772) 204-2909
(772) 785-8138
Mailing address
683 SW PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34953-1998
(561) 275-7100
(561) 275-7199

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
009406903
FL
Enumeration date
06/22/2020
Last updated
12/23/2024
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