Provider Demographics
NPI:1558666412
Name:JEREZ, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:JEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1033
Mailing Address - Country:US
Mailing Address - Phone:305-444-2939
Mailing Address - Fax:305-444-2966
Practice Address - Street 1:115 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1033
Practice Address - Country:US
Practice Address - Phone:305-444-2939
Practice Address - Fax:305-444-2966
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM 26039208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMM 26039OtherSTATE LICENSE