Provider Demographics
NPI:1437237823
Name:LLJ MEDICAL SERVICES CORP
Entity Type:Organization
Organization Name:LLJ MEDICAL SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAZARO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-480-7170
Mailing Address - Street 1:9145 SW 40TH ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-5371
Mailing Address - Country:US
Mailing Address - Phone:305-480-7170
Mailing Address - Fax:305-480-7150
Practice Address - Street 1:9145 SW 40TH ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5371
Practice Address - Country:US
Practice Address - Phone:305-480-7170
Practice Address - Fax:305-480-7150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6204261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC6204OtherAHCA LICENSE