Provider Demographics
NPI:1710338454
Name:JAPH MEDICAL GROUP INC
Entity Type:Organization
Organization Name:JAPH MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF JAPH MEDICAL GROUP INC
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:PRIETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-202-6322
Mailing Address - Street 1:7600 W 20TH AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1821
Mailing Address - Country:US
Mailing Address - Phone:305-557-0000
Mailing Address - Fax:305-557-0002
Practice Address - Street 1:7600 W 20TH AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1821
Practice Address - Country:US
Practice Address - Phone:305-557-0000
Practice Address - Fax:305-557-0002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAPH MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 54503261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272088400Medicaid