MEDICARE: MR. JACOB GABRIEL OROZCO I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1548006802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JACOB GABRIEL OROZCO I

Provider Business Mailing Address
First Line	:	1471 NW 194TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-3450
Country	:	US
Telephone Number	:	910-273-0213
Fax Number	:

Provider Business Practice Location Address
First Line	:	1471 NW 194TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-3450
Country	:	US
Telephone Number	:	910-273-0213
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2024
Last Update Date	:	07/06/2024

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