| Jose J Dergan P. A | |
|
8249 Nw 36th St Ste 100 Doral FL 33166-6673 | |
| (305) 599-1970 | |
| (305) 599-1971 |
| Full Name | Jose J Dergan P. A |
|---|---|
| Speciality | Psychologist |
| Location | 8249 Nw 36th St Ste 100, Doral, Florida |
| Authorized Official Name and Position | Lourdes Dergan (MANAGER) |
| Authorized Official Contact | 3055991970 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jose J Dergan P. A 8249 Nw 36th St Ste 100 Doral FL 33166-6673 Ph: (305) 599-1970 | Jose J Dergan P. A 8249 Nw 36th St Ste 100 Doral FL 33166-6673 Ph: (305) 599-1970 |
| NPI Number | 1063714178 |
|---|---|
| Provider Enumeration Date | 11/22/2010 |
| Last Update Date | 05/24/2011 |
| Medicare PECOS PAC ID | 3971789132 |
|---|---|
| Medicare Enrollment ID | O20110524000317 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063714178 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY4206 (Florida) | Primary |
| Provider Name | Jose J Dergan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629160817 PECOS PAC ID: 0345426482 Enrollment ID: I20110608000536 |
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