Provider Demographics
NPI:1114525276
Name:PEREZ MOLINA, JORGE ALBERTO (THM)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:ALBERTO
Last Name:PEREZ MOLINA
Suffix:
Gender:M
Credentials:THM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4924 EAGLESMERE DR APT 337
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5621
Mailing Address - Country:US
Mailing Address - Phone:407-766-0694
Mailing Address - Fax:
Practice Address - Street 1:518 PEACHTREE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6813
Practice Address - Country:US
Practice Address - Phone:407-730-7983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225XM0800X
225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Single Specialty