Provider Demographics
NPI:1598290504
Name:CARMENATE SERRANO, JORGE
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:CARMENATE SERRANO
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 1:8311 SW 142ND AVE APT I104
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4064
Mailing Address - Country:US
Mailing Address - Phone:786-870-3876
Mailing Address - Fax:
Practice Address - Street 1:8311 SW 142ND AVE APT I104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4064
Practice Address - Country:US
Practice Address - Phone:786-870-3876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician