Provider Demographics
NPI:1982751616
Name:DUARTE, JOSE
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:DUARTE
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 1:7150 W 20TH AVE
Mailing Address - Street 2:SUITE 615
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5529
Mailing Address - Country:US
Mailing Address - Phone:305-822-3044
Mailing Address - Fax:305-822-8782
Practice Address - Street 1:7150 W 20TH AVE
Practice Address - Street 2:SUITE 615
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5529
Practice Address - Country:US
Practice Address - Phone:305-822-3044
Practice Address - Fax:305-822-8782
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA 9100372OtherLICENSE