Provider Demographics
NPI:1922347483
Name:JORLE, CARMEN LUZ (MASTEROF EDUCATION)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:LUZ
Last Name:JORLE
Suffix:
Gender:F
Credentials:MASTEROF EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 E 157TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-4529
Mailing Address - Country:US
Mailing Address - Phone:917-567-9140
Mailing Address - Fax:
Practice Address - Street 1:429 E 157TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-4529
Practice Address - Country:US
Practice Address - Phone:917-567-9140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY718451174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist