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General NPI Number Information
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NPI Number | 1477568178
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Entity Type | Organization
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Legal Business Name | JACKSON MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 13850 NW 41ST ST
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City | DORAL
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State | FL
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Zip | 33178-3004
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Country | US
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Telephone | 786-263-4935
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Fax |
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Provider Business Mailing Address
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Address Line | 405 NW 130TH ST
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City | NORTH MIAMI
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State | FL
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Zip | 33168-3746
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Country | US
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Telephone | 305-685-7277
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Fax |
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Authorized Official
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Title or Position | NP
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Name | MS. ATHENA L LUZOD
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Credential | ARNP, MSN
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Telephone | 786-263-4935
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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 | 1245132
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License Number State | FL
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