Provider Demographics
NPI:1295459816
Name:COSIO PINERO, JORGE
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:COSIO PINERO
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 1:8424 NW 139TH TER APT 2707
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6701
Mailing Address - Country:US
Mailing Address - Phone:305-298-1523
Mailing Address - Fax:
Practice Address - Street 1:8424 NW 139TH TER APT 2707
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-6701
Practice Address - Country:US
Practice Address - Phone:305-298-1523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-204979106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician