Basic Information
| Provider Information | |||||||||
| NPI: | 1811093735 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMAYA | ||||||||
| FirstName: | JORGE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11501 SW 40TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331653313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056425366 | ||||||||
| FaxNumber: | 3056313828 | ||||||||
| Practice Location | |||||||||
| Address1: | 6825 SW 59TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331431907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7864939557 | ||||||||
| FaxNumber: | 3058213666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 10/06/2016 | ||||||||
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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 | 207R00000X | ME 47888 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208D00000X | ME 47888 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.