Healthcare Provider Details

I. General information

NPI: 1689358095
Provider Name (Legal Business Name): INEDA JEANLOUIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 NE 130TH ST
NORTH MIAMI FL
33161-7526
US

IV. Provider business mailing address

301 NE 165TH ST
MIAMI FL
33162-3549
US

V. Phone/Fax

Practice location:
  • Phone: 786-508-5968
  • Fax:
Mailing address:
  • Phone: 786-308-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278P1004X
TaxonomyPulmonary Diagnostics Certified Respiratory Therapist
License Number15548
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: