Provider Demographics
NPI:1891733465
Name:JORAM MEDICAL GROUP CENTER INC
Entity Type:Organization
Organization Name:JORAM MEDICAL GROUP CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-450-9556
Mailing Address - Street 1:9526 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2750
Mailing Address - Country:US
Mailing Address - Phone:305-757-8982
Mailing Address - Fax:305-757-8983
Practice Address - Street 1:9526 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2750
Practice Address - Country:US
Practice Address - Phone:305-757-8982
Practice Address - Fax:305-757-8983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Multi-Specialty