Provider Information for 1154609246
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JUAN M ANGEL MFT
Sex: Male
NPI: 1154609246
Last Updated: 2019-10-30
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1154609246 | ||||||||||||
| Enumeration Date | 2011-07-24 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 6001 SW 70TH ST APT 328 SOUTH MIAMI, FL 33143-3429 United States Phone: 954-648-9492 | Fax: | ||||||||||||
| Primary Practice Address | 7001 SW 97TH AVE STE 208 MIAMI, FL 33173-1410 United States Phone: 954-648-9492 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 315 TURK ST | ||||||||||||
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