Provider Demographics
NPI:1710392451
Name:THE HEALTH DIRECT GROUP, LLC
Entity Type:Organization
Organization Name:THE HEALTH DIRECT GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDO
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:305-615-2660
Mailing Address - Street 1:444 BRICKELL AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2403
Mailing Address - Country:US
Mailing Address - Phone:305-615-2660
Mailing Address - Fax:
Practice Address - Street 1:10350 PINES BLVD STE D102
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-6051
Practice Address - Country:US
Practice Address - Phone:786-286-1864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization