Provider Demographics
NPI:1194855494
Name:MIAMI MEDICAL GROUP & HOLISTIC CARE INC.
Entity Type:Organization
Organization Name:MIAMI MEDICAL GROUP & HOLISTIC CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:AP DOM
Authorized Official - Phone:305-445-0048
Mailing Address - Street 1:4505 W FLAGLER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1500
Mailing Address - Country:US
Mailing Address - Phone:305-445-0048
Mailing Address - Fax:305-569-0071
Practice Address - Street 1:4505 W FLAGLER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33134-1500
Practice Address - Country:US
Practice Address - Phone:305-445-0048
Practice Address - Fax:305-569-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175L00000XOther Service ProvidersHomeopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2894OtherCERTIFICATE OF EXCEMPTION