Provider Demographics
NPI:1700223492
Name:CRESPO, JULIO L
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:L
Last Name:CRESPO
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 1:3869 NW 62ND CT
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2129
Mailing Address - Country:US
Mailing Address - Phone:786-369-6702
Mailing Address - Fax:
Practice Address - Street 1:17009 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1003
Practice Address - Country:US
Practice Address - Phone:954-628-3802
Practice Address - Fax:954-441-7967
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 251B00000X
FLAPRN11004591363LF0000X
FL2023063403363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily