Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003420894 |
---|---|
Provider Name | Jorge L Soca Martinez |
First Address | Miami, FL 33193-5066 |
Second Address | Miami, FL 33193-5066 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2020 |
Last Update Date | 22/10/2020 |