Provider Demographics
NPI:1528806163
Name:CPJA CORP
Entity type:Organization
Organization Name:CPJA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:BALTODANO FALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-394-9064
Mailing Address - Street 1:17900 NW 5TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2809
Mailing Address - Country:US
Mailing Address - Phone:305-394-9064
Mailing Address - Fax:786-590-1909
Practice Address - Street 1:17900 NW 5TH ST STE 104
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2809
Practice Address - Country:US
Practice Address - Phone:305-394-9064
Practice Address - Fax:786-590-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty