Provider Demographics
NPI:1063521649
Name:JARAMILLO, LOURDES
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12526 SW 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5176
Mailing Address - Country:US
Mailing Address - Phone:305-238-6884
Mailing Address - Fax:
Practice Address - Street 1:3705 W 20TH AVE
Practice Address - Street 2:STE 125
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4531
Practice Address - Country:US
Practice Address - Phone:305-558-2629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT 22398OtherLICENSE #