Healthcare Provider Details

I. General information

NPI: 1306780606
Provider Name (Legal Business Name): JDK HEALTH, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SW 72ND ST STE 160
MIAMI FL
33173-3031
US

IV. Provider business mailing address

10300 SW 72ND ST STE 160
MIAMI FL
33173-3031
US

V. Phone/Fax

Practice location:
  • Phone: 305-299-0443
  • Fax: 205-927-0190
Mailing address:
  • Phone: 305-299-0443
  • Fax: 205-927-0190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA GONZALEZ
Title or Position: OWNER
Credential: APRN
Phone: 305-299-0443