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General NPI Number Information
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NPI Number | 1003231804
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Entity Type | Organization
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Legal Business Name | ST JUDE MEDICAL CLINIC INC
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Dates
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Enumeration Date | 03/03/2014
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Last Update Date | 03/21/2014
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Provider Practice Location Address
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Address Line | 5200 SW 8TH ST SUITE 200
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City | CORAL GABLES
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State | FL
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Zip | 33134-2300
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Country | US
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Telephone | 305-569-0349
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Fax |
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Provider Business Mailing Address
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Address Line | 5200 SW 8TH ST SUITE 200
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City | CORAL GABLES
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State | FL
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Zip | 33134-2300
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Country | US
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Telephone | 305-569-0349
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUAN C RIVERON
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Credential |
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Telephone | 305-569-0349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | HCC10040
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License Number State | FL
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