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General NPI Number Information
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NPI Number | 1720633548
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Entity Type | Individual
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Provider Name | JORGE DE LA PAZ
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Gender | Male
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Dates
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Enumeration Date | 08/08/2019
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 23429 SW 129TH AVE
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City | PRINCETON
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State | FL
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Zip | 33032-9219
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Country | US
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Telephone | 786-314-3691
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Fax |
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Provider Business Mailing Address
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Address Line | 23429 SW 129TH AVE
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City | PRINCETON
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State | FL
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Zip | 33032-9219
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Country | US
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Telephone | 786-314-3691
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-25-85699
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License Number State | FL
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