Healthcare Provider Details

I. General information

NPI: 1033794847
Provider Name (Legal Business Name): JWH LITTLE HAVANA, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 SW 1ST. STREET
MIAMI FL
33130
US

IV. Provider business mailing address

9100 S DADELAND BLVD STE 1400
MIAMI FL
33156-7816
US

V. Phone/Fax

Practice location:
  • Phone: 305-545-9292
  • Fax:
Mailing address:
  • Phone: 305-614-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DAIMILSIS SALGADO
Title or Position: DIR OF PROVIDER RELATIONS
Credential:
Phone: 305-614-7740