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NPI Code Detail

MEDICARE: CARLOS JESUS JANZEN P.T.A.

MEDICARE: CARLOS JESUS JANZEN P.T.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityPTA22746FL

General Provider Information

NPI Number : 1043581010
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLOS JESUS JANZEN P.T.A.
Provider Business Mailing Address
First Line : 579 CALIBRE CREST PKWY APT 204
Second Line :
City : ALTAMONTE SPRINGS
State : FL
Zip : 32714-3635
Country : US
Telephone Number : 407-484-6708
Fax Number :
Provider Business Practice Location Address
First Line : 15204 W COLONIAL DR
Second Line :
City : WINTER GARDEN
State : FL
Zip : 34787-6042
Country : US
Telephone Number : 407-877-2394
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2012
Last Update Date : 01/23/2012

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