Provider Demographics
NPI:1578194411
Name:JARAMILLO DE LA TORRE, JORGE JAVIER (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:JAVIER
Last Name:JARAMILLO DE LA TORRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CUAUHTEMOC 380
Mailing Address - Street 2:COL. MODERNA
Mailing Address - City:SAN LUIS POTOSI
Mailing Address - State:SLP
Mailing Address - Zip Code:78233
Mailing Address - Country:MX
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CUAUHTEMOC 380
Practice Address - Street 2:COL. MODERNA
Practice Address - City:SAN LUIS POTOSI
Practice Address - State:SLP
Practice Address - Zip Code:78233
Practice Address - Country:MX
Practice Address - Phone:444-811-5092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ4743174207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery