Basic Information
Provider Information
NPI: 1720272479
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARIAS GARAU
FirstName: JESSICA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: ARIAS GARAU
OtherFirstName: JESSICA
OtherMiddleName:  
OtherNamePrefix: DR.
OtherNameSuffix:  
OtherCredential: M.D.
OtherLastNameType: 2
Mailing Information
Address1: 4725 N FEDERAL HWY
Address2:  
City: FORT LAUDERDALE
State: FL
PostalCode: 333084603
CountryCode: US
TelephoneNumber: 9542297962
FaxNumber:  
Practice Location
Address1: 4725 N FEDERAL HWY
Address2:  
City: FORT LAUDERDALE
State: FL
PostalCode: 333084603
CountryCode: US
TelephoneNumber: 9542297962
FaxNumber: 9542297913
Other Information
ProviderEnumerationDate: 09/05/2007
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2081P2900XME121714FLY Allopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine

No ID Information.


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