Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | ME0038333 | FL |
NPI | 1003815929 |
---|---|
Provider Name | Jaime Carrizosa |
First Address | Altamonte Springs, FL 32701-7853 |
Second Address | Altamonte Springs, FL 32701-7853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 17/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
061927200 | (05) | FL |
D57063 | (02) |