Provider Demographics
NPI:1366536484
Name:J.A. PROFESSIONAL SERVICES, INC.
Entity type:Organization
Organization Name:J.A. PROFESSIONAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:H
Authorized Official - Last Name:AGUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:RADIOLOGIC TECHNOLOG
Authorized Official - Phone:305-358-6705
Mailing Address - Street 1:540 BRICKELL KEY DR
Mailing Address - Street 2:SUITE1209
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2697
Mailing Address - Country:US
Mailing Address - Phone:305-358-6705
Mailing Address - Fax:305-372-1092
Practice Address - Street 1:540 BRICKELL KEY DR
Practice Address - Street 2:SUITE1209
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-2697
Practice Address - Country:US
Practice Address - Phone:305-358-6705
Practice Address - Fax:305-372-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33322261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV1882OtherPROVIDER BC & BS
FLE1712Medicare ID - Type UnspecifiedPROVIDER