Provider Demographics
NPI:1346653375
Name:IGLESIAS, JOSE (LPN)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:IGLESIAS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3745
Mailing Address - Country:US
Mailing Address - Phone:305-222-2000
Mailing Address - Fax:305-222-2309
Practice Address - Street 1:10401 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3745
Practice Address - Country:US
Practice Address - Phone:305-222-2000
Practice Address - Fax:305-222-2309
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN 5172389164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse