Basic Information
| Provider Information | |||||||||
| NPI: | 1649451295 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAX'S FAMILY CARE AND RESEARCH CENTER, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5233 RICKER RD STE 101 | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322241148 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5233 RICKER RD STE 101 | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322241148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044256963 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2007 | ||||||||
| LastUpdateDate: | 11/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | DE LA HOZ | ||||||||
| AuthorizedOfficialFirstName: | JAIRO | ||||||||
| AuthorizedOfficialMiddleName: | ANTONIO | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9044256963 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | BBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | ME70797 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.