Healthcare Provider Details

I. General information

NPI: 1265824387
Provider Name (Legal Business Name): JORDYCO DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 BISCAYNE BLVD STE 301
MIAMI FL
33137-3730
US

IV. Provider business mailing address

3915 BISCAYNE BLVD STE 301
MIAMI FL
33137-3730
US

V. Phone/Fax

Practice location:
  • Phone: 561-200-2566
  • Fax:
Mailing address:
  • Phone: 561-200-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberLC11484
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLC11484
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberLC11484
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License NumberLC11484
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberLC11484
License Number StateFL

VIII. Authorized Official

Name: ISABEL PANESSO
Title or Position: CREDENTIALING
Credential:
Phone: 561-200-2566