Healthcare Provider Details

I. General information

NPI: 1508140047
Provider Name (Legal Business Name): JOSEPHIN MATHAI D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD
MIAMI BEACH FL
33140
US

IV. Provider business mailing address

5350 ALTON RD
MIAMI BEACH FL
33140
US

V. Phone/Fax

Practice location:
  • Phone: 305-535-7953
  • Fax:
Mailing address:
  • Phone: 954-699-6252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS11192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: