Provider Demographics
NPI:1831913235
Name:AGUNDEZ, JUAN CARLOS
Entity type:Individual
Prefix:
First Name:JUAN CARLOS
Middle Name:
Last Name:AGUNDEZ
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 1:1800 N BAYSHORE DR APT 3202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-3232
Mailing Address - Country:US
Mailing Address - Phone:786-897-4919
Mailing Address - Fax:
Practice Address - Street 1:1800 N BAYSHORE DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-3251
Practice Address - Country:US
Practice Address - Phone:786-897-4919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist