Individual
JORGE LUIS PEREZ CLAVIJO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1905 NW 82ND AVE, DORAL, FL 33126-1011
(786) 420-5924
Mailing address
4271 SW 5TH TER, CORAL GABLES, FL 33134-1948
(305) 922-7180
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
CBHCM101723
FL
363L00000X
Nurse Practitioner
Primary
RN9485164
FL
Other
Enumeration date
10/10/2018
Last updated
10/10/2018
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