Provider Demographics
NPI:1306605464
Name:LORA RODRIGUEZ, JORGE JAVIER
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:JAVIER
Last Name:LORA RODRIGUEZ
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 1:1910 SANDRA LN
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6543
Mailing Address - Country:US
Mailing Address - Phone:561-729-9430
Mailing Address - Fax:
Practice Address - Street 1:1910 SANDRA LN
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-6543
Practice Address - Country:US
Practice Address - Phone:561-718-4492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-334476106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician