Provider Demographics
NPI:1619926037
Name:LORITES, JESUS (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:LORITES
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 1:10740 W FLAGLER ST STE 12
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-4405
Mailing Address - Country:US
Mailing Address - Phone:305-800-2562
Mailing Address - Fax:305-902-5655
Practice Address - Street 1:10740 W FLAGLER ST STE 12
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-4405
Practice Address - Country:US
Practice Address - Phone:305-800-2562
Practice Address - Fax:786-360-4529
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME95227OtherSTATE LICENSE
FL1158457OtherCAQH
FL1026247OtherWORKERS COMP
FL280907900Medicaid
FLBL9186138OtherDEA
FLI56434Medicare UPIN
FL280907900Medicaid