Provider Demographics
NPI:1346937687
Name:FERNANDEZ GALVEZ, JOHNY
Entity Type:Individual
Prefix:
First Name:JOHNY
Middle Name:
Last Name:FERNANDEZ GALVEZ
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 1:1500 BAY RD APT 576
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3220
Mailing Address - Country:US
Mailing Address - Phone:786-378-2384
Mailing Address - Fax:
Practice Address - Street 1:1500 BAY RD APT 576
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-3220
Practice Address - Country:US
Practice Address - Phone:786-378-2384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician