Individual
JORGE LUIS MAYORGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
9863 SW 184TH ST, PALMETTO BAY, FL 33157-6934
(305) 252-6454
Mailing address
10633 HAMMOCKS BLVD, APT 1028, MIAMI, FL 33196-4719
(786) 360-2110
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA11099
FL
Other
Enumeration date
03/16/2011
Last updated
03/16/2011
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