Basic Information
| Provider Information | |||||||||
| NPI: | 1861712077 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TERRAZAS | ||||||||
| FirstName: | JOSELUIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8110 ROYAL PALM BLVD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330655795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543418288 | ||||||||
| FaxNumber: | 9543415165 | ||||||||
| Practice Location | |||||||||
| Address1: | 8110 ROYAL PALM BLVD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330655795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543418288 | ||||||||
| FaxNumber: | 9543415165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2010 | ||||||||
| LastUpdateDate: | 01/18/2022 | ||||||||
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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 | 207V00000X | ME119774 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 14V4E | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 012552800 | 05 | FL | MEDICAID |