Healthcare Provider Details

I. General information

NPI: 1891393112
Provider Name (Legal Business Name): JESSICA SOCORRO MAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DEL PRADO BLVD N STE L
CAPE CORAL FL
33909-6303
US

IV. Provider business mailing address

19 DEL PRADO BLVD N STE L
CAPE CORAL FL
33909-6303
US

V. Phone/Fax

Practice location:
  • Phone: 239-341-5658
  • Fax:
Mailing address:
  • Phone: 786-444-8319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: