MEDICARE: JOSHUA MEDICAL CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1609464106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSHUA MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	1865 N CORPORATE LAKES BLVD STE 2A
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-3273
Country	:	US
Telephone Number	:	347-730-9759
Fax Number	:

Provider Business Practice Location Address
First Line	:	1865 N CORPORATE LAKES BLVD STE 2A
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-3273
Country	:	US
Telephone Number	:	347-730-9759
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOELLE ESTRADA
Credential	:	MD
Telephone Number	:	347-730-9759

Provider Enumeration Date	:	01/09/2021
Last Update Date	:	01/09/2021

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