Provider Demographics
NPI:1225056120
Name:JAO MEDICAL CENTER
Entity Type:Organization
Organization Name:JAO MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORCASITA-NG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-441-9919
Mailing Address - Street 1:17901 NW 5TH ST
Mailing Address - Street 2:SUITE 21-22
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2810
Mailing Address - Country:US
Mailing Address - Phone:954-441-9919
Mailing Address - Fax:954-441-8162
Practice Address - Street 1:17901 NW 5TH ST
Practice Address - Street 2:SUITE 21-22
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2810
Practice Address - Country:US
Practice Address - Phone:954-441-9919
Practice Address - Fax:954-441-8162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049312207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1382Medicare ID - Type Unspecified