Provider Demographics
NPI:1053569251
Name:PUCHE, JOSE
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:PUCHE
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 1:181 NW 97 AVENUE
Mailing Address - Street 2:SUITE 313
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172
Mailing Address - Country:US
Mailing Address - Phone:305-661-2396
Mailing Address - Fax:305-661-2396
Practice Address - Street 1:181 NW 97 AVENUE
Practice Address - Street 2:SUITE 313
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172
Practice Address - Country:US
Practice Address - Phone:305-661-2396
Practice Address - Fax:305-661-2396
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor