Provider Demographics
NPI:1194790162
Name:DEL RISCO, JESUS L (CRNA)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:L
Last Name:DEL RISCO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 SW 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7574
Mailing Address - Country:US
Mailing Address - Phone:305-662-2925
Mailing Address - Fax:305-662-2341
Practice Address - Street 1:3100 S DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6914
Practice Address - Country:US
Practice Address - Phone:305-662-2925
Practice Address - Fax:305-662-2341
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2016-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2512552367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302566700Medicaid
FLG2559OtherBCBS
FLG2559OtherBCBS
FLE1210ZMedicare ID - Type Unspecified
FLE1210VMedicare ID - Type Unspecified