Provider Demographics
NPI:1477734234
Name:KAJAAL MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:KAJAAL MEDICAL SERVICES INC
Other - Org Name:KAJAAL MEDICAL SERVICES INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:LUCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KODAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN-ARNP
Authorized Official - Phone:305-588-4258
Mailing Address - Street 1:1701 NE 191ST ST
Mailing Address - Street 2:SUITE # A401
Mailing Address - City:N MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4200
Mailing Address - Country:US
Mailing Address - Phone:305-588-4258
Mailing Address - Fax:
Practice Address - Street 1:1701 NE 191ST ST
Practice Address - Street 2:SUITE # A401
Practice Address - City:N MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4200
Practice Address - Country:US
Practice Address - Phone:305-588-4258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAJAAL MEDICAL SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-21
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363LP0808363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9082Medicare PIN