Provider Demographics
NPI:1750632972
Name:JWH MIAMI LAKES II, INC
Entity Type:Organization
Organization Name:JWH MIAMI LAKES II, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:POZO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:305-614-7740
Mailing Address - Street 1:2600 DOUGLAS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-614-7740
Mailing Address - Fax:305-558-9578
Practice Address - Street 1:16320 NW 59 AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014
Practice Address - Country:US
Practice Address - Phone:305-558-1444
Practice Address - Fax:305-558-9578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS004878208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD60738Medicare UPIN