Provider Demographics
NPI:1841051380
Name:ROSQUETE PEREZ, JORGE AMEL
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:AMEL
Last Name:ROSQUETE PEREZ
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 1:7315 W 2ND CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5003
Mailing Address - Country:US
Mailing Address - Phone:786-545-9862
Mailing Address - Fax:
Practice Address - Street 1:7315 W 2ND CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5003
Practice Address - Country:US
Practice Address - Phone:786-545-9862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-312852106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty