Healthcare Provider Details

I. General information

NPI: 1306605464
Provider Name (Legal Business Name): JORGE JAVIER LORA RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1696 S MILITARY TRL STE C
WEST PALM BEACH FL
33415-5625
US

IV. Provider business mailing address

1910 SANDRA LN
PALM SPRINGS FL
33406-6543
US

V. Phone/Fax

Practice location:
  • Phone: 561-718-4492
  • Fax:
Mailing address:
  • Phone: 561-729-9430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-334476
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: