MEDICARE: GABRIEL JARAMILLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN19088	FL

General Provider Information

NPI Number	:	1205147238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL JARAMILLO

Provider Business Mailing Address
First Line	:	7011 CYPRESS TER
Second Line	:	101
City	:	FORT MYERS
State	:	FL
Zip	:	33907-8800
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7011 CYPRESS TER
Second Line	:	101
City	:	FORT MYERS
State	:	FL
Zip	:	33907-8800
Country	:	US
Telephone Number	:	239-433-5001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2010
Last Update Date	:	06/24/2010

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