Provider Demographics
NPI:1750632972
Name:JWH MIAMI LAKES II, LLC
Entity type:Organization
Organization Name:JWH MIAMI LAKES II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROVIDER RELATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:DAIMILSIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SALGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-614-7740
Mailing Address - Street 1:9100 S DADELAND BLVD STE 1400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7816
Mailing Address - Country:US
Mailing Address - Phone:305-614-7740
Mailing Address - Fax:305-558-9578
Practice Address - Street 1:16320 NW 59 AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014
Practice Address - Country:US
Practice Address - Phone:305-558-1444
Practice Address - Fax:305-558-9578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS004878208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD60738Medicare UPIN