Provider Demographics
NPI:1114787405
Name:ALZURI HERNANDEZ, JORGE RAINIER (PA)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:RAINIER
Last Name:ALZURI HERNANDEZ
Suffix:
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 1:8820 N NEW WORLD DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-5022
Mailing Address - Country:US
Mailing Address - Phone:786-656-3710
Mailing Address - Fax:
Practice Address - Street 1:8820 N NEW WORLD DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-5022
Practice Address - Country:US
Practice Address - Phone:786-656-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1816363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant