Healthcare Provider Details

I. General information

NPI: 1962411454
Provider Name (Legal Business Name): JD MOBILE HEALTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 STILL FOREST TERRACE
SANFORD FL
32771-8371
US

IV. Provider business mailing address

PO BOX 951433
LAKE MARY FL
32795-1433
US

V. Phone/Fax

Practice location:
  • Phone: 407-416-7172
  • Fax: 407-321-9337
Mailing address:
  • Phone: 407-416-7172
  • Fax: 407-321-9337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAVIER DELGADO
Title or Position: PRESIDENT
Credential:
Phone: 407-419-7172