Provider Demographics
NPI:1134669484
Name:FERNANDEZ DEL TORO, JUAN
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:FERNANDEZ DEL TORO
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 1:15190 SW 136TH ST
Mailing Address - Street 2:UNIT 26
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15190 SW 136TH ST
Practice Address - Street 2:UNIT 26
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-2604
Practice Address - Country:US
Practice Address - Phone:786-701-3109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No374U00000XNursing Service Related ProvidersHome Health Aide