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General NPI Number Information
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NPI Number | 1376877787
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Entity Type | Individual
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Provider Name | JESUS ORNELAS M.D
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Gender | Male
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Dates
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Enumeration Date | 10/01/2009
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 8620 SW 146TH ST
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City | PALMETTO BAY
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State | FL
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Zip | 33158
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Country | US
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Telephone | 305-395-9589
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Fax |
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Provider Business Mailing Address
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Address Line | 8620 SW 146TH ST
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City | PALMETTO BAY
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State | FL
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Zip | 33158-1443
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Country | US
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Telephone | 305-395-9589
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Fax |
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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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | ME118252
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 25MA09102700
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License Number State | NJ
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