Provider Demographics
NPI:1700484888
Name:ALVAREZ FEITO, JORGE CARLOS
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:CARLOS
Last Name:ALVAREZ FEITO
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 1:2227 WHITE PINE CIR APT A
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33415-5902
Mailing Address - Country:US
Mailing Address - Phone:561-307-9343
Mailing Address - Fax:
Practice Address - Street 1:2221 WHITE PINE CIR APT D
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33415-5900
Practice Address - Country:US
Practice Address - Phone:561-568-9367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-138807106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-20-138807OtherBACB