Provider Demographics
NPI:1548742950
Name:ALARCON ZAMBRANO, JORGE NAYID
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:NAYID
Last Name:ALARCON ZAMBRANO
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 1:796 HILL DR APT D
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-3771
Mailing Address - Country:US
Mailing Address - Phone:786-383-5304
Mailing Address - Fax:
Practice Address - Street 1:796 HILL DR APT D
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-3771
Practice Address - Country:US
Practice Address - Phone:786-383-5304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL01-295246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant