Provider Demographics
NPI:1063189017
Name:GOVIN AMADOR, JORGE (CSA)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:GOVIN AMADOR
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8814 NW 180TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6503
Mailing Address - Country:US
Mailing Address - Phone:786-390-4789
Mailing Address - Fax:
Practice Address - Street 1:8814 NW 180TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-6503
Practice Address - Country:US
Practice Address - Phone:786-390-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant