Healthcare Provider Details

I. General information

NPI: 1144896077
Provider Name (Legal Business Name): JL PSYCH SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13168 SW 188TH ST
MIAMI FL
33177-3002
US

IV. Provider business mailing address

13168 SW 188TH ST
MIAMI FL
33177-3002
US

V. Phone/Fax

Practice location:
  • Phone: 305-812-8815
  • Fax:
Mailing address:
  • Phone: 305-812-8815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON LOPEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 305-812-8815