Provider Demographics
NPI:1447764824
Name:LORA, JOSE LUIS (ARNP)
Entity type:Individual
Prefix:
First Name:JOSE LUIS
Middle Name:
Last Name:LORA
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9035 NW 168TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6341
Mailing Address - Country:US
Mailing Address - Phone:305-725-0872
Mailing Address - Fax:
Practice Address - Street 1:2387 W 68TH ST STE 402
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-6890
Practice Address - Country:US
Practice Address - Phone:305-822-4447
Practice Address - Fax:305-822-4484
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9332373363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily