=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306917174
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J.J.C. MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6716 W FLAGLER ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-2924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-517-4608
-----------------------------------------------------
Fax | 786-517-4610
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1509 SW 104TH PL
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33174-2670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-216-3697
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | YENI LOPEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-216-3697
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------