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General NPI Number Information
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NPI Number | 1669560439
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Entity Type | Organization
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Legal Business Name | JMMV PA
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8370 W FLAGLER ST SUITE #222
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City | MIAMI
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State | FL
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Zip | 33144-2094
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Country | US
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Telephone | 305-225-4266
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Fax | 305-225-4267
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Provider Business Mailing Address
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Address Line | 12930 SW 128TH ST SUITE 204-A3
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City | MIAMI
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State | FL
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Zip | 33186-6038
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Country | US
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Telephone | 305-238-9199
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Fax | 305-238-1551
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MR. HAN LOBATO
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Credential |
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Telephone | 305-238-9199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME18675
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License Number State | FL
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