Basic Information
| Provider Information | |||||||||
| NPI: | 1407823925 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE JONGH | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6101 BLUE LAGOON DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331263168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055002000 | ||||||||
| FaxNumber: | 3055002145 | ||||||||
| Practice Location | |||||||||
| Address1: | 3233 PALM AVE | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330125427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058260660 | ||||||||
| FaxNumber: | 8448307363 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2006 | ||||||||
| LastUpdateDate: | 09/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME108474 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 32971 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 881848 | 05 | AZ | MEDICAID | P00342747 | 01 | AZ | RAILROAD MEDICARE | OTHER | AZ0766001 | 01 | AZ | BCBS AZ | OTHER |