Provider Demographics
NPI:1043049661
Name:PINALES, JOSE ABEL
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ABEL
Last Name:PINALES
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 1:2867 CAMOMILE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7502
Mailing Address - Country:US
Mailing Address - Phone:919-527-9777
Mailing Address - Fax:
Practice Address - Street 1:2867 CAMOMILE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7502
Practice Address - Country:US
Practice Address - Phone:919-527-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-356220106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician