Organization
ST. JOHN CLINIC MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. REYNALDO CRUZ (CEO)
(305) 576-0231
Entity
Organization
Contact information
Practice address
161 NW 29TH ST, MIAMI, FL 33127-3929
(305) 576-0231
(305) 573-1458
Mailing address
161 NW 29TH ST, MIAMI, FL 33127-3929
(305) 576-0231
(305) 573-1458
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
FL
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
FL
261QP2300X
Primary Care Clinic/Center
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060387200
—
FL
01
—
4624
TOTAL HEALTH CHOICE
FL
Enumeration date
10/13/2005
Last updated
07/21/2022
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