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General NPI Number Information
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NPI Number | 1639773377
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Entity Type | Individual
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Provider Name | JOSE I DEL RISCO
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Gender | Male
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Dates
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Enumeration Date | 11/23/2020
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 10450 NW 33RD ST UNIT 205
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City | DORAL
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State | FL
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Zip | 33172-1005
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Country | US
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Telephone | 786-206-3155
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Fax | 786-772-2009
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Provider Business Mailing Address
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Address Line | 8855 NW 180TH TER
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City | HIALEAH
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State | FL
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Zip | 33018-6504
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Country | US
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Telephone | 786-200-0628
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11010383
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License Number State | FL
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