Provider Demographics
NPI:1578846614
Name:JORDAN, LAMITSOI KHAILYLAH (LM)
Entity Type:Individual
Prefix:
First Name:LAMITSOI
Middle Name:KHAILYLAH
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 NE 44TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3413
Mailing Address - Country:US
Mailing Address - Phone:305-340-1189
Mailing Address - Fax:
Practice Address - Street 1:57 NE 44TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3413
Practice Address - Country:US
Practice Address - Phone:305-340-1189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL246176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife