Healthcare Provider Details

I. General information

NPI: 1558276105
Provider Name (Legal Business Name): JULIO JORGE, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9560 SW 107TH AVE STE 104
MIAMI FL
33176-2790
US

IV. Provider business mailing address

9560 SW 107TH AVE STE 104
MIAMI FL
33176-2790
US

V. Phone/Fax

Practice location:
  • Phone: 305-470-9002
  • Fax:
Mailing address:
  • Phone: 305-470-9002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA SOSA
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 305-549-8937