Healthcare Provider Details

I. General information

NPI: 1457682817
Provider Name (Legal Business Name): JC HEALTHCARE PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 SW 40TH ST
MIAMI FL
33165-3947
US

IV. Provider business mailing address

10101 SW 40TH ST
MIAMI FL
33165-3947
US

V. Phone/Fax

Practice location:
  • Phone: 305-551-9989
  • Fax: 305-551-9910
Mailing address:
  • Phone: 305-551-9989
  • Fax: 305-551-9910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME0068785
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9214359
License Number StateFL

VIII. Authorized Official

Name: DR. JOSE F CARDONA
Title or Position: OWNER
Credential: M.D.
Phone: 305-551-9989