Basic Information
| Provider Information | |||||||||
| NPI: | 1003198144 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JORGE PUIG | ||||||||
| FirstName: | YISSEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 445 E 25TH ST | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330133810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056245366 | ||||||||
| FaxNumber: | 3056313803 | ||||||||
| Practice Location | |||||||||
| Address1: | 445 E 25TH ST | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330133810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056245366 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2011 | ||||||||
| LastUpdateDate: | 09/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME119374 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.