1235724782 NPI number — KLEAR HEALTH SYSTEMS INC

Table of content: JORDON STREETER LABORATORY DIRECTOR (NPI 1710870795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235724782 NPI number — KLEAR HEALTH SYSTEMS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KLEAR HEALTH SYSTEMS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235724782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
419 W 49TH ST STE 212
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33012-3657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-456-1775
Provider Business Mailing Address Fax Number:
786-703-9266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
419 W 49TH ST STE 212
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33012-3657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-456-1775
Provider Business Practice Location Address Fax Number:
786-703-9266
Provider Enumeration Date:
03/06/2021

Additional Information

Authorized Official

Authorized Official Last Name:
BATISTA RIZO
Authorized Official First Name:
HILDA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
619-560-6001

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 109775800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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