Active NPI
Jose R Mijares, SA-C
- Surgical Assistant
- Clermont, FL
National Provider Identifier
1972166924
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 19-192
- Practice address
- 255 Citrus Tower Blvd Ste 101
Clermont, FL 34711-1906 - Phone
- (352) 394-0893
- Fax
- (352) 243-1188
- NPI assigned
- Apr 16, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 19-192 | Primary |
Addresses
Primary practice location
255 Citrus Tower Blvd Ste 101
Clermont, FL 34711-1906
Mailing address
2844 Magnolia Blossom Cir
Clermont, FL 34711-7493
Phone (352) 460-2569
Other practice location 1
14501 Gatorland Dr
Orlando, FL 32837-6916
Phone (407) 931-0070
Other practice location 2
483 N Semoran Blvd Ste 102
Winter Park, FL 32792-3800
Phone (407) 645-1847
Other practice location 3
2844 Magnolia Blossom Cir
Clermont, FL 34711-7493
Phone (352) 460-2569
Other practice location 4
2239 North Blvd W
Davenport, FL 33837-8990
Phone (863) 419-1418
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555632000000",
"number": "1972166924",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2844 MAGNOLIA BLOSSOM CIR",
"city": "CLERMONT",
"state": "FL",
"postal_code": "347117493",
"telephone_number": "352-460-2569"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 CITRUS TOWER BLVD STE 101",
"city": "CLERMONT",
"state": "FL",
"postal_code": "347111906",
"telephone_number": "352-394-0893",
"fax_number": "352-243-1188"
}
],
"practiceLocations": [
{
"address_1": "14501 Gatorland Dr",
"address_purpose": "LOCATION",
"city": "Orlando",
"state": "FL",
"postal_code": "328376916",
"country_code": "US",
"telephone_number": "407-931-0070",
"fax_number": "407-816-4174",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "483 N Semoran Blvd Ste 102",
"address_purpose": "LOCATION",
"city": "Winter Park",
"state": "FL",
"postal_code": "327923800",
"country_code": "US",
"telephone_number": "407-645-1847",
"fax_number": "321-274-0246",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2844 Magnolia Blossom Cir",
"address_purpose": "LOCATION",
"city": "Clermont",
"state": "FL",
"postal_code": "347117493",
"country_code": "US",
"telephone_number": "352-460-2569",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2239 North Blvd W",
"address_purpose": "LOCATION",
"city": "Davenport",
"state": "FL",
"postal_code": "338378990",
"country_code": "US",
"telephone_number": "863-419-1418",
"fax_number": "863-419-1809",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MIJARES",
"first_name": "JOSE",
"middle_name": "R",
"credential": "SA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-04-16",
"last_updated": "2019-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": null,
"license": "19-192",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clermont, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.