MEDICARE: JORGE ANTONIO EXPOSITO ORTIZ

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	RBT-23-308558	FL

General Provider Information

NPI Number	:	1730957788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE ANTONIO EXPOSITO ORTIZ

Provider Business Mailing Address
First Line	:	2960 NELSON ST APT 4
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-6046
Country	:	US
Telephone Number	:	239-228-0929
Fax Number	:

Provider Business Practice Location Address
First Line	:	2960 NELSON ST APT 4
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-6046
Country	:	US
Telephone Number	:	239-228-0929
Fax Number	:

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

Provider Enumeration Date	:	12/19/2023
Last Update Date	:	02/26/2026

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