Organization
JUVENICE PROFESSIONAL CENTER CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUIS CHEDIAK (PRESIDENT)
(305) 910-9170
Entity
Organization
Contact information
Practice address
8567 CORAL WAY, SUITE 112, MIAMI, FL 33155-2335
(305) 910-9170
(305) 513-5189
Mailing address
8567 CORAL WAY, SUITE 112, MIAMI, FL 33155-2335
(305) 910-9170
(305) 513-5189
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
PT19963
FL
305R00000X
Preferred Provider Organization
Primary
ME61828
FL
Other
Enumeration date
04/15/2009
Last updated
05/25/2009
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