Provider Demographics
NPI:1104194786
Name:SASTOQUE, JUAN
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:SASTOQUE
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 1:3900 NW 79TH AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6556
Mailing Address - Country:US
Mailing Address - Phone:305-597-3861
Mailing Address - Fax:305-597-3863
Practice Address - Street 1:3354 SW 156TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4737
Practice Address - Country:US
Practice Address - Phone:786-442-5015
Practice Address - Fax:305-597-3863
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst