Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | ||
N | 225XM0800X | Mental Health | FL |
NPI | 1114525276 |
---|---|
Provider Name | Mr. Jorge Alberto Perez Molina |
First Address | Orlando, FL 32819-5621 |
Second Address | Orlando, FL 32804-6813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2020 |
Last Update Date | 12/10/2020 |