Provider Demographics
NPI:1932440666
Name:IZQUIERDO, JESUS (TCM)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:
Last Name:IZQUIERDO
Suffix:
Gender:M
Credentials:TCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12691 NW 9TH WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2061
Mailing Address - Country:US
Mailing Address - Phone:786-317-0665
Mailing Address - Fax:
Practice Address - Street 1:12691 NW 9TH WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33182-2061
Practice Address - Country:US
Practice Address - Phone:786-317-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker