Healthcare Provider Details

I. General information

NPI: 1366599029
Provider Name (Legal Business Name): JOEL PLATTOR PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 MADRUGA AVE SUITE 310
CORAL GABLES FL
33146-3148
US

IV. Provider business mailing address

1450 MADRUGA AVE SUITE 310
CORAL GABLES FL
33146-3148
US

V. Phone/Fax

Practice location:
  • Phone: 305-663-5808
  • Fax: 305-663-5809
Mailing address:
  • Phone: 305-663-5808
  • Fax: 305-663-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY4582
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: