Provider Demographics
NPI:1356746069
Name:PLASENCIA, JESUS R (BC-HIS)
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:R
Last Name:PLASENCIA
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 PALM WAY APT 307
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-1180
Mailing Address - Country:US
Mailing Address - Phone:786-260-7902
Mailing Address - Fax:
Practice Address - Street 1:8028 NW 154TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5814
Practice Address - Country:US
Practice Address - Phone:305-362-9098
Practice Address - Fax:305-362-3165
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4768237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist