| Organization Name: | SPORT MEDICAL CENTER CORP |
| NPI Number: | 1235421876 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HISELA CASTRO (PRESIDENT) |
| Mailing Address: | 6501 Nw 36th St Ste 302 Virginia Gardens |
| State: | FL US |
| Postal Code: | 331666959 |
| Phone Number: | 3055261599 |
| Fax Number: | 3055261699 |
| NPI Enumeration Date: | 05/13/2011 |
| NPI Last Update Date: | 05/13/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | HCC9156 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |