Provider Demographics
NPI:1083049241
Name:REMIREZ, MARIO JOSE JR (PA)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:JOSE
Last Name:REMIREZ
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4970
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32802-4970
Mailing Address - Country:US
Mailing Address - Phone:407-446-5760
Mailing Address - Fax:407-836-3315
Practice Address - Street 1:3855 S JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-8652
Practice Address - Country:US
Practice Address - Phone:407-446-5760
Practice Address - Fax:407-836-3315
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100248363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant