Provider Demographics
NPI:1316537830
Name:VILLATORO, JUAN P (RMHCI)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:P
Last Name:VILLATORO
Suffix:
Gender:M
Credentials:RMHCI
Other - Prefix:
Other - First Name:JUAN PABLO
Other - Middle Name:
Other - Last Name:VILLATORO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:729 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-7158
Mailing Address - Country:US
Mailing Address - Phone:954-658-6299
Mailing Address - Fax:
Practice Address - Street 1:6971 N FEDERAL HWY STE 206
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1648
Practice Address - Country:US
Practice Address - Phone:561-408-1098
Practice Address - Fax:561-408-1099
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13869163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health