Healthcare Provider Details

I. General information

NPI: 1679684393
Provider Name (Legal Business Name): JMH-PUBLIC HEALTH TRUST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EDGEWATER DR APT 101
CORAL GABLES FL
33133-6937
US

IV. Provider business mailing address

100 EDGEWATER DR APT 101
CORAL GABLES FL
33133-6937
US

V. Phone/Fax

Practice location:
  • Phone: 305-663-7135
  • Fax: 305-355-2161
Mailing address:
  • Phone: 305-663-7135
  • Fax: 305-355-2161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number1320812
License Number StateFL

VIII. Authorized Official

Name: MS. LORETTA CONTRERAS
Title or Position: NURSE PRACTITIONER
Credential: ARNP
Phone: 30558585365