Provider Demographics
NPI:1821223959
Name:JACKSON CLINIC CENTER, INC.
Entity Type:Organization
Organization Name:JACKSON CLINIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-234-5699
Mailing Address - Street 1:8770 SW 72ND ST # 307
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3512
Mailing Address - Country:US
Mailing Address - Phone:786-234-5699
Mailing Address - Fax:702-549-9256
Practice Address - Street 1:8770 SW 72ND ST # 307
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3512
Practice Address - Country:US
Practice Address - Phone:786-234-5699
Practice Address - Fax:702-549-9256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty