Healthcare Provider Details

I. General information

NPI: 1548593056
Provider Name (Legal Business Name): SOUTH FLORIDA OCCUPATIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S MIAMI AVE
MIAMI FL
33130-4100
US

IV. Provider business mailing address

1250 S MIAMI AVE
MIAMI FL
33130-4100
US

V. Phone/Fax

Practice location:
  • Phone: 305-571-6250
  • Fax: 305-571-6251
Mailing address:
  • Phone: 305-571-6250
  • Fax: 305-571-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License NumberME81042
License Number StateFL

VIII. Authorized Official

Name: DR. HOSSEIN JOUKAR
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 305-571-6250