Healthcare Provider Details

I. General information

NPI: 1710839840
Provider Name (Legal Business Name): JORGE ENRIQUE IZQUIERDO PAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 NW 79TH AVE
DORAL FL
33166-6508
US

IV. Provider business mailing address

4353 NW 77TH AVE FL 3
MIAMI FL
33166-6736
US

V. Phone/Fax

Practice location:
  • Phone: 305-400-4605
  • Fax: 866-611-2870
Mailing address:
  • Phone: 305-204-0333
  • Fax: 305-359-7546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11045005
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: