Provider Demographics
NPI:1710211834
Name:SOUTH FLORIDA OCCUPATIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:SOUTH FLORIDA OCCUPATIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOUKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-827-3303
Mailing Address - Street 1:5590 W 20TH AVE
Mailing Address - Street 2:#101
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-7070
Mailing Address - Country:US
Mailing Address - Phone:305-827-3303
Mailing Address - Fax:305-819-6634
Practice Address - Street 1:5590 W 20TH AVE
Practice Address - Street 2:#101
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-7070
Practice Address - Country:US
Practice Address - Phone:305-827-3303
Practice Address - Fax:305-819-6634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81042261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine