Provider Demographics
NPI:1669560439
Name:JMMV PA
Entity type:Organization
Organization Name:JMMV PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOBATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-238-9199
Mailing Address - Street 1:12930 SW 128TH ST
Mailing Address - Street 2:SUITE 204-A3
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6038
Mailing Address - Country:US
Mailing Address - Phone:305-238-9199
Mailing Address - Fax:305-238-1551
Practice Address - Street 1:8370 W FLAGLER ST
Practice Address - Street 2:SUITE #222
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2094
Practice Address - Country:US
Practice Address - Phone:305-225-4266
Practice Address - Fax:305-225-4267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME18675208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6411Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION#