Provider Demographics
NPI:1679930606
Name:PEREZ GONZALEZ, JORGE E (RBT)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:E
Last Name:PEREZ GONZALEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3537 PEPPERVINE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4859
Mailing Address - Country:US
Mailing Address - Phone:336-554-1289
Mailing Address - Fax:
Practice Address - Street 1:1518 STONEYWOOD WAY
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-1912
Practice Address - Country:US
Practice Address - Phone:407-212-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
FLRBT-15-10829106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1679930606Medicaid