MEDICARE: JESUS PRIETO

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
1	172V00000X	Community Health Worker	AL12312	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154707610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESUS PRIETO

Provider Business Mailing Address
First Line	:	939 PARK MANOR DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-6744
Country	:	US
Telephone Number	:	407-432-6785
Fax Number	:	407-897-7452

Provider Business Practice Location Address
First Line	:	939 PARK MANOR DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-6744
Country	:	US
Telephone Number	:	407-432-6785
Fax Number	:	407-897-7452

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2015
Last Update Date	:	08/07/2015

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Directions to “ JESUS PRIETO ” Practice Location

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