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General NPI Number Information
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NPI Number | 1023863719
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Entity Type | Individual
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Provider Name | JORGE Y MELENDEZ NORIEGA MA
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Gender | Male
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Dates
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Enumeration Date | 04/17/2024
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 390 CROWN OAK CENTRE DR
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City | LONGWOOD
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State | FL
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Zip | 32750-6149
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Country | US
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Telephone | 787-590-7285
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Fax |
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Provider Business Mailing Address
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Address Line | 5150 BOGGY CREEK RD LOT Q10
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City | SAINT CLOUD
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State | FL
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Zip | 34771-9246
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Country | US
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Telephone | 787-590-7285
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMT4092
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License Number State | FL
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