Provider Demographics
NPI:1215752225
Name:JCARRIAZO MD P.L.L.C.
Entity type:Organization
Organization Name:JCARRIAZO MD P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRIAZO ISASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-326-8080
Mailing Address - Street 1:14998 SW 37TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-2747
Mailing Address - Country:US
Mailing Address - Phone:786-564-1116
Mailing Address - Fax:
Practice Address - Street 1:2 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3355
Practice Address - Country:US
Practice Address - Phone:786-564-1116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty