Healthcare Provider Details

I. General information

NPI: 1417880832
Provider Name (Legal Business Name): FJNR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 SW 40TH AVE
WEST PARK FL
33023-6224
US

IV. Provider business mailing address

3990 SW 40TH AVE
WEST PARK FL
33023-6224
US

V. Phone/Fax

Practice location:
  • Phone: 786-487-1009
  • Fax: 786-487-1009
Mailing address:
  • Phone: 786-487-1009
  • Fax: 786-487-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name: JENNY DOREUS
Title or Position: OWNER
Credential:
Phone: 786-487-1009