Provider Demographics
NPI:1003420894
Name:SOCA MARTINEZ, JORGE L
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:L
Last Name:SOCA MARTINEZ
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 1:15480 SW 82ND LN APT 217
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5066
Mailing Address - Country:US
Mailing Address - Phone:786-416-1932
Mailing Address - Fax:
Practice Address - Street 1:15480 SW 82ND LN APT 217
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5066
Practice Address - Country:US
Practice Address - Phone:786-416-1932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician