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NPI Code Detail

MEDICARE: CITRUS HEALTH NETWORK, INC.

MEDICARE: CITRUS HEALTH NETWORK, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician
2261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1982062485
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITRUS HEALTH NETWORK, INC.
Provider Business Mailing Address
First Line : 4175 W 20TH AVE
Second Line :
City : HIALEAH
State : FL
Zip : 33012-5874
Country : US
Telephone Number : 305-825-0300
Fax Number :
Provider Business Practice Location Address
First Line : 777 E 25TH ST STE 316
Second Line :
City : HIALEAH
State : FL
Zip : 33013-3849
Country : US
Telephone Number : 305-825-0300
Fax Number :
Authorized Official
Title or Position : PRESIDENT & CEO
Name : MARIO JARDON
Credential : LCSW
Telephone Number : 305-825-0300
Provider Enumeration Date : 01/29/2016
Last Update Date : 01/03/2023

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Directions to “CITRUS HEALTH NETWORK, INC. ” Practice Location

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