Provider Demographics
NPI:1700312428
Name:ALCANTARA JORGE, ELSIS
Entity Type:Individual
Prefix:
First Name:ELSIS
Middle Name:
Last Name:ALCANTARA JORGE
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 1:8305 CRESPI BLVD APT 5C
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-1386
Mailing Address - Country:US
Mailing Address - Phone:305-413-6939
Mailing Address - Fax:
Practice Address - Street 1:8305 CRESPI BLVD APT 5C
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-1386
Practice Address - Country:US
Practice Address - Phone:305-413-6939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician