Provider Demographics
NPI:1073784781
Name:DEL TORO FAGUNDO, YERKO
Entity Type:Individual
Prefix:
First Name:YERKO
Middle Name:
Last Name:DEL TORO FAGUNDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6716 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2924
Mailing Address - Country:US
Mailing Address - Phone:305-263-7383
Mailing Address - Fax:305-263-7385
Practice Address - Street 1:6716 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2924
Practice Address - Country:US
Practice Address - Phone:305-263-7383
Practice Address - Fax:305-263-7385
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7714111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty