Organization
ST JUDE MEDICAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUAN RIVERON (OWNER)
(305) 569-0349
Entity
Organization
Contact information
Practice address
5200 SW 8TH ST, SUITE 200, CORAL GABLES, FL 33134-2300
(305) 569-0349
Mailing address
5200 SW 8TH ST, SUITE 200, CORAL GABLES, FL 33134-2300
(305) 569-0349
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
HCC10040
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HCC10040
HEALTH CARE CLINIC
FL
Enumeration date
12/26/2013
Last updated
03/03/2014
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