Healthcare Provider Details

I. General information

NPI: 1164216669
Provider Name (Legal Business Name): MEJ FIRST SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6175 NW 153RD ST STE 301
MIAMI LAKES FL
33014-2443
US

IV. Provider business mailing address

6175 NW 153RD ST STE 301
MIAMI LAKES FL
33014-2443
US

V. Phone/Fax

Practice location:
  • Phone: 561-527-3577
  • Fax:
Mailing address:
  • Phone: 561-527-3577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JORGE DIAZ VALDES
Title or Position: PRESIDENT
Credential: M.D
Phone: 561-527-3577