Provider Demographics
NPI:1891900429
Name:JORGE, IRENE I
Entity Type:Individual
Prefix:MISS
First Name:IRENE
Middle Name:
Last Name:JORGE
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 10 BOX 4885
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9623
Mailing Address - Country:US
Mailing Address - Phone:787-789-9551
Mailing Address - Fax:
Practice Address - Street 1:PEDIATRIC UNIVERSITY HOSPITAL- MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:787-763-1093
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2230104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker