Provider Demographics
NPI:1467046714
Name:ARMIJO, JOSE M
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:ARMIJO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5462 BEVERLY RISE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-5103
Mailing Address - Country:US
Mailing Address - Phone:813-400-8814
Mailing Address - Fax:
Practice Address - Street 1:1150 BELL SHOALS RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-9001
Practice Address - Country:US
Practice Address - Phone:813-681-6064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114089207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine