Provider Demographics
NPI:1114113065
Name:JORGE L. MACIA, M.D.& ROSA M. MARIN M.D.,P.A.
Entity Type:Organization
Organization Name:JORGE L. MACIA, M.D.& ROSA M. MARIN M.D.,P.A.
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:L
Authorized Official - Last Name:MACIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-732-2701
Mailing Address - Street 1:115 SE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-4905
Mailing Address - Country:US
Mailing Address - Phone:561-732-2701
Mailing Address - Fax:561-732-0354
Practice Address - Street 1:115 SE 4TH ST
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-4905
Practice Address - Country:US
Practice Address - Phone:561-732-2701
Practice Address - Fax:561-732-0354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG64886Medicare UPIN
FLG54629Medicare UPIN