Dergan, Jose J

Dergan, Jose J is an sole proprietor health care provider with primary practice located at 8249 Nw 36Th St Ste 102 , Doral FL 33166-6673. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Dergan, Jose J can be contacted via phone (305) 599-1970.

Contact Information

Primary practice address
8249 Nw 36Th St Ste 102 Doral FL 33166-6673
Phone: (305) 599-1970
Fax: (305) 599-1971
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X PY 004206 Florida

Profile Details

NPI number 1629160817
LBN Legal business name Dergan, Jose J
Credentials PSY.D
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 28th, 2006
Last updated Nov 22nd, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629160817 NPPES
Florida Other 65-0167578 TAX IDENTIFICATION
Florida MEDICAID 210099100 TAX IDENTIFICATION

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