Provider Demographics
NPI:1053082792
Name:ORELLANA PLAZA, JOSE RAUL
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:RAUL
Last Name:ORELLANA PLAZA
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 1:2461 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1909
Mailing Address - Country:US
Mailing Address - Phone:347-987-6841
Mailing Address - Fax:
Practice Address - Street 1:2461 E 28TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1909
Practice Address - Country:US
Practice Address - Phone:347-987-6841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032179225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist