Healthcare Provider Details

I. General information

NPI: 1679804769
Provider Name (Legal Business Name): JOSE R AZARET, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11880 BIRD RD SUITE 319
MIAMI FL
33175-3584
US

IV. Provider business mailing address

11880 BIRD RD SUITE 319
MIAMI FL
33175-3584
US

V. Phone/Fax

Practice location:
  • Phone: 305-551-6260
  • Fax: 305-220-1258
Mailing address:
  • Phone: 305-551-6260
  • Fax: 305-220-1258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27866
License Number StateFL

VIII. Authorized Official

Name: DR. JOSE R AZARET
Title or Position: PRESIDENT
Credential: MD
Phone: 305-551-6260