Healthcare Provider Details

I. General information

NPI: 1952064115
Provider Name (Legal Business Name): DANIEL SANTOS FRUTOS PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 12/09/2023
Certification Date: 12/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15233 NW 87TH CT
MIAMI LAKES FL
33018-1359
US

IV. Provider business mailing address

15233 NW 87TH CT
MIAMI LAKES FL
33018-1359
US

V. Phone/Fax

Practice location:
  • Phone: 305-733-9525
  • Fax: 305-470-7457
Mailing address:
  • Phone: 305-733-9525
  • Fax: 305-470-7457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11015901
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: