Provider Demographics
NPI:1659477123
Name:JAPH MEDICAL GROUP INC
Entity Type:Organization
Organization Name:JAPH MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:PRIETO-HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-202-6322
Mailing Address - Street 1:7600 W 20TH AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1895
Mailing Address - Country:US
Mailing Address - Phone:305-557-0000
Mailing Address - Fax:305-557-0000
Practice Address - Street 1:7600 W 20TH AVE STE 112
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1895
Practice Address - Country:US
Practice Address - Phone:305-557-0000
Practice Address - Fax:305-557-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0054503OtherMEDICAL DOCTOR