Illumina Medical Group JV, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ILLUMINA MEDICAL GROUP JV, LLC

Practice address

1914 NW 84TH Ave
Doral, FL 33126

Phone

(305) 254-8900

NPI assigned

Jun 28, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Angel Mongeotti

Title

Executive Director of Finance

Phone

(305) 254-8900

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1530144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532649600000",
    "number": "1699260950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1914 NW 84TH AVE",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331261030",
            "telephone_number": "305-254-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1914 NW 84TH AVE",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "33126",
            "telephone_number": "305-254-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUMINA MEDICAL GROUP JV, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-28",
        "last_updated": "2018-07-27",
        "status": "A",
        "authorized_official_last_name": "MONGEOTTI",
        "authorized_official_first_name": "ANGEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "305-254-8900"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Doral, FL
• Providers in Doral, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.