MEDICARE: JORGE A PEREZ PUPO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	24375517	FL

General Provider Information

NPI Number	:	1285452284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE A PEREZ PUPO

Provider Business Mailing Address
First Line	:	8615 NW 8TH ST APT 402
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-5930
Country	:	US
Telephone Number	:	786-283-0641
Fax Number	:

Provider Business Practice Location Address
First Line	:	8615 NW 8TH ST APT 402
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-5930
Country	:	US
Telephone Number	:	786-283-0641
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2024
Last Update Date	:	09/30/2024

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Directions to “ JORGE A PEREZ PUPO ” Practice Location

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