Healthcare Provider Details

I. General information

NPI: 1144496423
Provider Name (Legal Business Name): JML PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6262 SW 40TH ST SUITE 2E
MIAMI FL
33155-4882
US

IV. Provider business mailing address

6262 SW 40TH ST SUITE 2E
MIAMI FL
33155-4882
US

V. Phone/Fax

Practice location:
  • Phone: 305-669-9689
  • Fax:
Mailing address:
  • Phone: 305-669-9689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME68564
License Number StateFL

VIII. Authorized Official

Name: HECTOR LABRADA
Title or Position: PRESIDENT
Credential: MD
Phone: 305-669-9689