Provider Demographics
NPI:1639773377
Name:DEL RISCO, JOSE I
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:I
Last Name:DEL RISCO
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 1:8855 NW 180TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6504
Mailing Address - Country:US
Mailing Address - Phone:786-200-0628
Mailing Address - Fax:
Practice Address - Street 1:12709 MIRAMAR PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2902
Practice Address - Country:US
Practice Address - Phone:305-266-2929
Practice Address - Fax:786-377-5451
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF11200686363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily