Provider Demographics
NPI:1043031362
Name:LABRADOR PORTALES, JAMIN
Entity type:Individual
Prefix:
First Name:JAMIN
Middle Name:
Last Name:LABRADOR PORTALES
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 1:3517 SAN MARTIN CT
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-1853
Mailing Address - Country:US
Mailing Address - Phone:561-662-4169
Mailing Address - Fax:
Practice Address - Street 1:420 S STATE ROAD 7 STE 174
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33414-4306
Practice Address - Country:US
Practice Address - Phone:561-568-9367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-19
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-378648106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician