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General NPI Number Information
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NPI Number | 1497064620
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Entity Type | Organization
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Legal Business Name | J & G THERAPEUTICS CENTER INC
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 10/05/2010
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Provider Practice Location Address
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Address Line | 5881 NW 151ST ST SUITE 106
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2450
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Country | US
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Telephone | 305-819-0655
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Fax | 305-819-0656
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Provider Business Mailing Address
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Address Line | 5881 NW 151ST ST SUITE 106
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2450
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Country | US
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Telephone | 305-819-0655
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Fax | 305-819-0656
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Authorized Official
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Title or Position | PRESIDENT
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Name | LUIS R TENDERO
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Credential | MA
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Telephone | 305-819-9655
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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 | HCC8423
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License Number State | FL
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