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General NPI Number Information
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NPI Number | 1356575427
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Entity Type | Organization
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Legal Business Name | JL GRAN SERVICES, INC
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Dates
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Enumeration Date | 05/05/2009
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Last Update Date | 05/05/2009
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Provider Practice Location Address
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Address Line | 3435 WESTWOOD DR
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City | TITUSVILLE
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State | FL
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Zip | 32796
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Country | US
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Telephone | 754-234-1184
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Fax | 321-445-4757
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Provider Business Mailing Address
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Address Line | 3435 WESTWOOD DR
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City | TITUSVILLE
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State | FL
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Zip | 32796
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Country | US
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Telephone | 754-234-1184
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Fax | 321-445-4757
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Authorized Official
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Title or Position | PRESIDENT
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Name | JORGE L MIRO
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Credential |
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Telephone | 754-234-1184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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