| Organization Name: | ST JUDE MEDICAL CLINIC INC |
| NPI Number: | 1700207479 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JUAN RIVERON (OWNER) |
| Mailing Address: | 5200 Sw 8th St Suite 200 Coral Gables |
| State: | FL US |
| Postal Code: | 331342300 |
| Phone Number: | 3055690349 |
| Fax Number: | |
| NPI Enumeration Date: | 12/26/2013 |
| NPI Last Update Date: | 03/03/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | HCC10040 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |