Provider Demographics
NPI:1437315868
Name:JACKSON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:JACKSON MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GERIATRIC FELLOW
Authorized Official - Prefix:DR
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:MARIANO
Authorized Official - Last Name:CANAVOSIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-575-7231
Mailing Address - Street 1:2625 COLLINS AVE
Mailing Address - Street 2:APT 411
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4746
Mailing Address - Country:US
Mailing Address - Phone:646-226-7834
Mailing Address - Fax:
Practice Address - Street 1:1201 NW 16TH ST
Practice Address - Street 2:VA HOSPITAL
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1624
Practice Address - Country:US
Practice Address - Phone:305-575-3173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital