Healthcare Provider Details

I. General information

NPI: 1659562601
Provider Name (Legal Business Name): JOHANA MEDICAL SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9821 SW 73RD CT
MIAMI FL
33156-3112
US

IV. Provider business mailing address

9821 SW 73RD CT
MIAMI FL
33156-3112
US

V. Phone/Fax

Practice location:
  • Phone: 305-510-2638
  • Fax: 305-662-7879
Mailing address:
  • Phone: 305-510-2638
  • Fax: 305-662-7879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME55656
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME55656
License Number StateFL

VIII. Authorized Official

Name: DR. OSCAR MENDOZA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-510-2638