Active NPI
Eduardo San Jorge
- Physical Therapist
- Miami Lakes, FL
National Provider Identifier
1871102806
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 35779
- Practice address
- 14900 NW 79TH CT Ste 101
Miami Lakes, FL 33016-5869 - Phone
- (305) 821-0502
- NPI assigned
- Jul 27, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 35779 | FL | Primary |
Addresses
Primary practice location
14900 NW 79TH CT Ste 101
Miami Lakes, FL 33016-5869
Mailing address
7966 NW 162ND St
Miami Lakes, FL 33016-6111
Phone (786) 683-9425
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35779 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595808000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595808000000",
"number": "1871102806",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7966 NW 162ND ST",
"city": "MIAMI LAKES",
"state": "FL",
"postal_code": "330166111",
"telephone_number": "786-683-9425"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14900 NW 79TH CT STE 101",
"city": "MIAMI LAKES",
"state": "FL",
"postal_code": "330165869",
"telephone_number": "305-821-0502"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAN JORGE",
"first_name": "EDUARDO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-27",
"last_updated": "2020-07-27",
"certification_date": "2020-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "35779",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Miami Lakes, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.