Healthcare Provider Details

I. General information

NPI: 1558030163
Provider Name (Legal Business Name): MRS. YOHANNA JORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 03/10/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9986 NW 127TH ST
HIALEAH GARDENS FL
33018-7433
US

IV. Provider business mailing address

9986 NW 127TH ST
HIALEAH GARDENS FL
33018-7433
US

V. Phone/Fax

Practice location:
  • Phone: 305-301-8074
  • Fax:
Mailing address:
  • Phone: 305-301-8074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-71405
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: