Healthcare Provider Details

I. General information

NPI: 1407617541
Provider Name (Legal Business Name): JORGE FELIZ VALERIO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 MOUNT VERNON ST
ORLANDO FL
32803-5417
US

IV. Provider business mailing address

1239 MOUNT VERNON ST
ORLANDO FL
32803-5417
US

V. Phone/Fax

Practice location:
  • Phone: 407-810-2773
  • Fax: 407-867-6203
Mailing address:
  • Phone: 407-810-2773
  • Fax: 407-867-6203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA18631
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: