Healthcare Provider Details

I. General information

NPI: 1265240014
Provider Name (Legal Business Name): 5497 WHITE AVE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6135 NW 39TH ST
VIRGINIA GARDENS FL
33166-7012
US

IV. Provider business mailing address

6135 NW 39TH ST
VIRGINIA GARDENS FL
33166-7012
US

V. Phone/Fax

Practice location:
  • Phone: 786-202-3457
  • Fax:
Mailing address:
  • Phone: 786-202-3457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JORGE LUIS MORALES
Title or Position: OWNER
Credential:
Phone: 786-202-3457