Provider Demographics
NPI:1083456305
Name:JARAMILLO, ADRIAN
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:JARAMILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9293 HIGHWAY 377
Mailing Address - Street 2:
Mailing Address - City:BLANKET
Mailing Address - State:TX
Mailing Address - Zip Code:76432-6339
Mailing Address - Country:US
Mailing Address - Phone:956-467-7078
Mailing Address - Fax:
Practice Address - Street 1:9293 HIGHWAY 377
Practice Address - Street 2:
Practice Address - City:BLANKET
Practice Address - State:TX
Practice Address - Zip Code:76432-6339
Practice Address - Country:US
Practice Address - Phone:956-467-7078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty