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DR. JOSE J DERGAN PSY.D

Clinical Neuropsychologist

Doral, Florida

Provider NPI: 1629160817

Provider Information:
DR. JOSE J DERGAN PSY.D
Gender: M
Sole Proprietor


Practice Location:
8249 NW 36TH ST STE 102  DORAL, FL 33166 US
Tel: 305-599-1970  Fax: 305-599-1971

Business Mailing Address:
8249 NW 36TH ST STE 102  DORAL, FL 33166 US
Tel: 305-599-1970  Fax: 305-599-1971

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103TC0700XBehavioral Health & Social Service Providers
Psychologist
Clinical
FLPY 004206

Other Provider Identifiers:

IssuerNumberStateType
TAX IDENTIFICATION65-0167578FL01
210099100FL05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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