Provider Demographics
NPI:1053705558
Name:CONESA, JOSE A (DO)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:CONESA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9646 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-8015
Mailing Address - Country:US
Mailing Address - Phone:305-846-9158
Mailing Address - Fax:305-846-9284
Practice Address - Street 1:9646 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-8015
Practice Address - Country:US
Practice Address - Phone:305-846-9158
Practice Address - Fax:305-846-9284
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO2224156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician