=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033293873
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JORGE I CASARIEGO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 11/02/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8600 SW 92ND ST SUITE 203
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156-7397
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-273-0027
-----------------------------------------------------
Fax | 305-595-8327
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 560130
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33256-0130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-630-9244
-----------------------------------------------------
Fax | 305-630-9223
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | ME0027919
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------