Provider Demographics
NPI:1487962601
Name:PARRA, JORGE LUIS JR (MA)
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:LUIS
Last Name:PARRA
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 W 8TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-1239
Mailing Address - Country:US
Mailing Address - Phone:786-267-2211
Mailing Address - Fax:
Practice Address - Street 1:4851 NW 79 AVE
Practice Address - Street 2:10
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-1239
Practice Address - Country:US
Practice Address - Phone:786-267-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA59566225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA59566OtherMASSAGE THERAPIST