Healthcare Provider Details

I. General information

NPI: 1437315868
Provider Name (Legal Business Name): JACKSON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST VA HOSPITAL
MIAMI FL
33125-1624
US

IV. Provider business mailing address

2625 COLLINS AVE APT 411
MIAMI BEACH FL
33140-4746
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-3173
  • Fax:
Mailing address:
  • Phone: 646-226-7834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. FEDERICO MARIANO CANAVOSIO
Title or Position: GERIATRIC FELLOW
Credential: MD
Phone: 305-575-7231