Provider Demographics
NPI:1518580562
Name:DE LA ROSA PEREZ, JORGE NELSON (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:NELSON
Last Name:DE LA ROSA PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13335 SW 124TH ST STE 212
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7515
Mailing Address - Country:US
Mailing Address - Phone:305-433-2488
Mailing Address - Fax:786-732-0460
Practice Address - Street 1:13335 SW 124TH ST STE 212
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7515
Practice Address - Country:US
Practice Address - Phone:305-433-2488
Practice Address - Fax:786-732-0460
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1357208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice