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General NPI Number Information
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NPI Number | 1548406838
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Entity Type | Organization
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Legal Business Name | JOSE E. JAEN MD PA
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Dates
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Enumeration Date | 12/17/2008
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Last Update Date | 06/17/2009
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Provider Practice Location Address
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Address Line | 7100 W 20TH AVE STE 302
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City | HIALEAH
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State | FL
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Zip | 33016-1897
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Country | US
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Telephone | 305-823-1555
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Fax | 305-823-4660
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Provider Business Mailing Address
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Address Line | 7100 W 20TH AVE SUITE 302
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City | HIALEAH
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State | FL
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Zip | 33016-1897
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Country | US
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Telephone | 305-823-1555
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Fax | 305-823-4660
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JOSE E JAEN
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Credential | M.D.
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Telephone | 305-823-1555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME38391
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License Number State | FL
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