Healthcare Provider Details

I. General information

NPI: 1063841575
Provider Name (Legal Business Name): SAINT JOSE INJURY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 CORAL WAY STE 106
MIAMI FL
33155-6500
US

IV. Provider business mailing address

7801 CORAL WAY STE 106
MIAMI FL
33155-6500
US

V. Phone/Fax

Practice location:
  • Phone: 305-752-0992
  • Fax:
Mailing address:
  • Phone: 305-752-0992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROXANA SUAREZ
Title or Position: OWNER
Credential:
Phone: 305-801-8114