Provider Demographics
NPI:1538473509
Name:JOLI ENTERPRISES OF BREVARD LLC
Entity Type:Organization
Organization Name:JOLI ENTERPRISES OF BREVARD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MENASHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-499-3413
Mailing Address - Street 1:2880 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:GRANT VALKARIA
Mailing Address - State:FL
Mailing Address - Zip Code:32949-8115
Mailing Address - Country:US
Mailing Address - Phone:321-499-3413
Mailing Address - Fax:
Practice Address - Street 1:2880 GRANT RD
Practice Address - Street 2:
Practice Address - City:GRANT VALKARIA
Practice Address - State:FL
Practice Address - Zip Code:32949-8115
Practice Address - Country:US
Practice Address - Phone:321-499-3413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076426207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty