MEDICARE: JORGE ENRIQUE IZQUIERDO PAZ

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	363L00000X	Nurse Practitioner	11045005	FL

General Provider Information

NPI Number	:	1710839840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE ENRIQUE IZQUIERDO PAZ

Provider Business Mailing Address
First Line	:	7797 W 29TH LN APT 201
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-5189
Country	:	US
Telephone Number	:	786-541-5202
Fax Number	:

Provider Business Practice Location Address
First Line	:	7797 W 29TH LN APT 201
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-5189
Country	:	US
Telephone Number	:	786-541-5202
Fax Number	:

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

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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