Healthcare Provider Details

I. General information

NPI: 1689188179
Provider Name (Legal Business Name): JORGE FERNANDO ARIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ARTHUR GODFREY RD STE 305
MIAMI FL
33140-3523
US

IV. Provider business mailing address

400 ARTHUR GODFREY RD STE 305
MIAMI FL
33140-3523
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-8586
  • Fax: 305-674-6686
Mailing address:
  • Phone: 305-674-8586
  • Fax: 305-674-6686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: