Provider Demographics
NPI:1255877932
Name:DESMARAIS, JOSE
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:DESMARAIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:561-793-1713
Mailing Address - Fax:561-793-3242
Practice Address - Street 1:12953 PALMS WEST DR STE 102
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470
Practice Address - Country:US
Practice Address - Phone:561-793-1713
Practice Address - Fax:561-793-3242
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9281329363LG0600X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology