MEDICARE: YERKO DEL TORO FAGUNDO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH7714	FL

General Provider Information

NPI Number	:	1073784781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YERKO DEL TORO FAGUNDO

Provider Business Mailing Address
First Line	:	6716 W FLAGLER ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-2924
Country	:	US
Telephone Number	:	305-263-7383
Fax Number	:	305-263-7385

Provider Business Practice Location Address
First Line	:	6716 W FLAGLER ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-2924
Country	:	US
Telephone Number	:	305-263-7383
Fax Number	:	305-263-7385

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2008
Last Update Date	:	03/20/2008

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