Provider Demographics
NPI:1548651912
Name:PLACENCIA, JOSE
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:PLACENCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6790 NW 186TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3353
Mailing Address - Country:US
Mailing Address - Phone:786-304-0189
Mailing Address - Fax:
Practice Address - Street 1:6790 NW 186TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3353
Practice Address - Country:US
Practice Address - Phone:786-304-0189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker