Provider Demographics
NPI:1952064115
Name:FRUTOS, DANIEL SANTOS (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:SANTOS
Last Name:FRUTOS
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15233 NW 87TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1359
Mailing Address - Country:US
Mailing Address - Phone:305-733-9525
Mailing Address - Fax:305-470-7457
Practice Address - Street 1:15233 NW 87TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33018-1359
Practice Address - Country:US
Practice Address - Phone:305-733-9525
Practice Address - Fax:305-470-7457
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11015901363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLO9774Medicaid