Provider Demographics
NPI:1699525196
Name:CARDENTEY, JORGE D
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:D
Last Name:CARDENTEY
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 1:9452 NW 120TH ST APT 527
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4011
Mailing Address - Country:US
Mailing Address - Phone:786-474-8337
Mailing Address - Fax:
Practice Address - Street 1:9452 NW 120TH ST APT 527
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4011
Practice Address - Country:US
Practice Address - Phone:786-474-8337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician