Basic Information
| Provider Information | |||||||||
| NPI: | 1700062494 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IGNACIO | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 806 S DOUGLAS RD | ||||||||
| Address2: | SUITE 820 | ||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331343157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054474150 | ||||||||
| FaxNumber: | 3054488186 | ||||||||
| Practice Location | |||||||||
| Address1: | 806 S DOUGLAS RD | ||||||||
| Address2: | SUITE 820 | ||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331343157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054474150 | ||||||||
| FaxNumber: | 3054488186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2008 | ||||||||
| LastUpdateDate: | 09/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS014320 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OS10614 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.