Provider Demographics
NPI:1407987738
Name:JARAMILLO, INES K (LDO)
Entity Type:Individual
Prefix:
First Name:INES
Middle Name:K
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4497 NW 185TH ST
Mailing Address - Street 2:
Mailing Address - City:CAROL CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33055-3079
Mailing Address - Country:US
Mailing Address - Phone:305-474-7421
Mailing Address - Fax:
Practice Address - Street 1:4497 NW 185TH ST
Practice Address - Street 2:
Practice Address - City:CAROL CITY
Practice Address - State:FL
Practice Address - Zip Code:33055-3079
Practice Address - Country:US
Practice Address - Phone:305-474-7421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2259156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL630146101Medicaid
FL630146103Medicaid
FL630146102Medicaid