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Organization
ILLUMINA MEDICAL GROUP JV, LLC
Active
Organization
ILLUMINA MEDICAL GROUP JV, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGEL MONGEOTTI (EXECUTIVE DIRECTOR OF FINANCE)
(305) 254-8900
Entity
Organization
Contact information
Practice address
1914 NW 84TH AVE, DORAL, FL 33126
(305) 254-8900
Mailing address
1914 NW 84TH AVE, DORAL, FL 33126-1030
(305) 254-8900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
06/28/2018
Last updated
07/27/2018
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