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General NPI Number Information
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NPI Number | 1053667527
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Entity Type | Organization
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Legal Business Name | JULIO JORGE MD PA
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 08/02/2012
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Provider Practice Location Address
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Address Line | 9560 SW 107TH AVE SUITE A104
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City | MIAMI
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State | FL
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Zip | 33176-2787
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Country | US
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Telephone | 305-596-1913
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Fax | 305-598-6788
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Provider Business Mailing Address
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Address Line | 9560 SW 107TH AVE SUITE A104
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City | MIAMI
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State | FL
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Zip | 33176-2787
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Country | US
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Telephone | 305-596-1913
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Fax | 305-598-6788
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Authorized Official
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Title or Position | BILLING AGENT
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Name | JUAN J LOPEZ
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Credential |
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Telephone | 305-251-3991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0064851
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License Number State | FL
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