Healthcare Provider Details

I. General information

NPI: 1619920170
Provider Name (Legal Business Name): JFK COMPLETE MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 NE 79TH ST SUITE 100
MIAMI FL
33138-4701
US

IV. Provider business mailing address

777 NE 79TH ST SUITE 100
MIAMI FL
33138-4701
US

V. Phone/Fax

Practice location:
  • Phone: 305-759-7275
  • Fax: 305-759-7276
Mailing address:
  • Phone: 305-759-7275
  • Fax: 305-759-7276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: YAMILET LUGO
Title or Position: PRESIDENT
Credential:
Phone: 305-868-6104