Provider Demographics
NPI:1891442893
Name:FRANCO ORTEGA, SIMON
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:FRANCO ORTEGA
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 1:5207 MONZA CT
Mailing Address - Street 2:
Mailing Address - City:AVE MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34142-5099
Mailing Address - Country:US
Mailing Address - Phone:239-986-1143
Mailing Address - Fax:
Practice Address - Street 1:5207 MONZA CT
Practice Address - Street 2:
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142-5099
Practice Address - Country:US
Practice Address - Phone:239-986-1143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBABC548176106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician