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General NPI Number Information
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NPI Number | 1659562601
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Entity Type | Organization
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Legal Business Name | JOHANA MEDICAL SERVICES CORP
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 07/06/2009
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Provider Practice Location Address
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Address Line | 9821 SW 73RD CT
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City | MIAMI
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State | FL
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Zip | 33156-3112
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Country | US
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Telephone | 305-510-2638
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Fax | 305-662-7879
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Provider Business Mailing Address
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Address Line | 9821 SW 73RD CT
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City | MIAMI
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State | FL
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Zip | 33156-3112
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Country | US
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Telephone | 305-510-2638
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Fax | 305-662-7879
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OSCAR MENDOZA
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Credential | M.D.
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Telephone | 305-510-2638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | ME55656
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME55656
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License Number State | FL
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