Provider Demographics
NPI:1548070220
Name:ESQUIVEL, JORGE ALEJANDRO
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:ALEJANDRO
Last Name:ESQUIVEL
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 1:2104 NW 152ND ST
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-2805
Mailing Address - Country:US
Mailing Address - Phone:786-630-7872
Mailing Address - Fax:
Practice Address - Street 1:2104 NW 152ND ST
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-2805
Practice Address - Country:US
Practice Address - Phone:786-484-9871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician