Healthcare Provider Details

I. General information

NPI: 1548317084
Provider Name (Legal Business Name): JEQUIPMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 W 68TH ST
HIALEAH FL
33016-1804
US

IV. Provider business mailing address

2118 W 68TH ST
HIALEAH FL
33016-1804
US

V. Phone/Fax

Practice location:
  • Phone: 786-439-1361
  • Fax: 786-439-1362
Mailing address:
  • Phone: 786-439-1361
  • Fax: 786-439-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number State

VIII. Authorized Official

Name: MR. JACOBO S ALONSO
Title or Position: PRESIDENT
Credential:
Phone: 786-439-1361