Provider Demographics
NPI:1710625827
Name:NARANJO PEREZ, JORGE LEANDRO
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:LEANDRO
Last Name:NARANJO PEREZ
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 1:12034 SW 208TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-5324
Mailing Address - Country:US
Mailing Address - Phone:305-710-4382
Mailing Address - Fax:
Practice Address - Street 1:12034 SW 208TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-5324
Practice Address - Country:US
Practice Address - Phone:305-710-4382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician