Healthcare Provider Details

I. General information

NPI: 1982062485
Provider Name (Legal Business Name): CITRUS HEALTH NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E 25TH ST STE 316
HIALEAH FL
33013-3849
US

IV. Provider business mailing address

4175 W 20TH AVE
HIALEAH FL
33012-5874
US

V. Phone/Fax

Practice location:
  • Phone: 305-825-0300
  • Fax:
Mailing address:
  • Phone: 305-825-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MARIO JARDON
Title or Position: PRESIDENT & CEO
Credential: LCSW
Phone: 305-825-0300