Provider Demographics
NPI:1043494537
Name:JORGE, CECILIA MARIE (MD)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:MARIE
Last Name:JORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 N KROME AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-6014
Mailing Address - Country:US
Mailing Address - Phone:786-481-5909
Mailing Address - Fax:786-481-5908
Practice Address - Street 1:31 N KROME AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-6014
Practice Address - Country:US
Practice Address - Phone:786-481-5909
Practice Address - Fax:786-481-5908
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME717992084P0800X, 2084P0805X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003236500Medicaid
FLH19401Medicare UPIN