Provider Demographics
NPI:1417562414
Name:JL LARIA APRN PA
Entity type:Organization
Organization Name:JL LARIA APRN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LARIA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:305-308-2513
Mailing Address - Street 1:5751A SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5301
Mailing Address - Country:US
Mailing Address - Phone:305-299-7290
Mailing Address - Fax:
Practice Address - Street 1:5751A SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5301
Practice Address - Country:US
Practice Address - Phone:305-299-7290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty