Healthcare Provider Details

I. General information

NPI: 1962369660
Provider Name (Legal Business Name): JORGE CARMONA PERAZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 W 35TH ST APT 26B
HIALEAH FL
33012-4878
US

IV. Provider business mailing address

1275 W 35TH ST APT 26B
HIALEAH FL
33012-4878
US

V. Phone/Fax

Practice location:
  • Phone: 786-256-0797
  • Fax:
Mailing address:
  • Phone: 786-256-0797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-498868
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: