Provider Demographics
NPI:1164044293
Name:JWH MIAMI LAKES I, LLC
Entity Type:Organization
Organization Name:JWH MIAMI LAKES I, LLC
Other - Org Name:JUSTWELL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTO
Authorized Official - Middle Name:L
Authorized Official - Last Name:POZO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:305-614-7740
Mailing Address - Street 1:2600 S DOUGLAS RD STE 400
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6134
Mailing Address - Country:US
Mailing Address - Phone:305-614-7740
Mailing Address - Fax:
Practice Address - Street 1:16320 NW 59 AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6879
Practice Address - Country:US
Practice Address - Phone:305-557-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty