Provider Demographics
NPI:1215685672
Name:NOVO PEREZ, JORGE MANUEL (RBT-21-151961)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:MANUEL
Last Name:NOVO PEREZ
Suffix:
Gender:M
Credentials:RBT-21-151961
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15313 SW 138TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-4649
Mailing Address - Country:US
Mailing Address - Phone:786-560-7388
Mailing Address - Fax:
Practice Address - Street 1:15313 SW 138TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-4649
Practice Address - Country:US
Practice Address - Phone:786-560-7388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110419800Medicaid