Provider Demographics
NPI:1235414186
Name:ESTEVEZ, JORGE JAVIER (LMT)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:JAVIER
Last Name:ESTEVEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 NW 87TH PL
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1201
Mailing Address - Country:US
Mailing Address - Phone:786-488-8615
Mailing Address - Fax:866-698-1090
Practice Address - Street 1:2404 NW 87TH PL
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1201
Practice Address - Country:US
Practice Address - Phone:786-488-8615
Practice Address - Fax:866-698-1090
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51598172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA51598OtherMASSAGE THERAPIST