Organization
PHYSICIAN SERVICE ORGANIZATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOEL LAGO (PRESIDENT)
(305) 263-1090
Entity
Organization
Contact information
Practice address
9425 SW 72ND ST, SUITE 211, MIAMI, FL 33173-3251
(305) 263-1090
(305) 263-1091
Mailing address
9425 SW 72NS STREET, SUITE 211, MIAMI, FL 33173
(305) 263-1090
(305) 263-1091
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
FL
Other
Enumeration date
04/22/2010
Last updated
04/22/2010
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