Provider Demographics
NPI:1255822532
Name:PADRON, JORGE
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:PADRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 SE 47TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-9679
Mailing Address - Country:US
Mailing Address - Phone:239-984-1711
Mailing Address - Fax:800-574-6208
Practice Address - Street 1:1222 SE 47TH ST STE 206
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9679
Practice Address - Country:US
Practice Address - Phone:239-984-1711
Practice Address - Fax:800-574-6208
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994769251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health