Provider Demographics
NPI:1609266170
Name:JORGE L. DE LA PEDRAJA, M.D., P.A.
Entity Type:Organization
Organization Name:JORGE L. DE LA PEDRAJA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DE LA PEDRAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-441-9144
Mailing Address - Street 1:3850 BIRD RD
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1501
Mailing Address - Country:US
Mailing Address - Phone:305-441-9144
Mailing Address - Fax:305-448-8994
Practice Address - Street 1:3850 BIRD RD
Practice Address - Street 2:SUITE # 102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33146-1501
Practice Address - Country:US
Practice Address - Phone:305-441-9144
Practice Address - Fax:305-448-8994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77828208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH39921Medicare PIN