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General NPI Number Information
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NPI Number | 1144398157
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Entity Type | Individual
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Provider Name | JORGE TRAVIESO MD
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Gender | Male
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 2369 W 52ND ST
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City | HIALEAH
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State | FL
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Zip | 33016-7210
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Country | US
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Telephone | 305-825-0587
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Fax | 305-825-7136
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Provider Business Mailing Address
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Address Line | 2369 W 52ND ST
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City | HIALEAH
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State | FL
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Zip | 33016-7210
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Country | US
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Telephone | 305-825-0587
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Fax | 305-825-7136
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0066409
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License Number State | FL
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