=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972867364
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASMIN JOSE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2012
-----------------------------------------------------
Last Update Date | 08/23/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6238 W ATLANTIC AVE STE 2
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33484
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-404-9845
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15748 GLENCREST AVE
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33446-9580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-642-3253
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | ME131951
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------