Healthcare Provider Details

I. General information

NPI: 1619030350
Provider Name (Legal Business Name): HENRI J DEJEAN RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 NE 173RD ST
N MIAMI BEACH FL
33162-2642
US

IV. Provider business mailing address

1020 NE 173RD ST
N MIAMI BEACH FL
33162-2642
US

V. Phone/Fax

Practice location:
  • Phone: 305-490-3678
  • Fax:
Mailing address:
  • Phone: 305-490-3678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberRT8137
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: