Provider Demographics
NPI:1649774811
Name:TRIAS, JORGE LUIS
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:TRIAS
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 1:3562 W 80TH ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7516
Mailing Address - Country:US
Mailing Address - Phone:786-647-4800
Mailing Address - Fax:
Practice Address - Street 1:3562 W 80TH ST UNIT 201
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-7516
Practice Address - Country:US
Practice Address - Phone:786-985-9262
Practice Address - Fax:305-742-2190
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician