Provider Demographics
NPI:1649965393
Name:RODRIGUEZ BELTRAN, JORGE CARLOS JR (RBT)
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:CARLOS
Last Name:RODRIGUEZ BELTRAN
Suffix:JR
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2811 RULEME ST APT 203
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6538
Mailing Address - Country:US
Mailing Address - Phone:502-291-3542
Mailing Address - Fax:
Practice Address - Street 1:2811 RULEME ST APT 203
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6538
Practice Address - Country:US
Practice Address - Phone:502-291-3542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-266559106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician