Healthcare Provider Details

I. General information

NPI: 1144939331
Provider Name (Legal Business Name): DR. RAUL DANIEL FAGUNDEZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7921 SW HIGHWAY 200
OCALA FL
34476-3976
US

IV. Provider business mailing address

7921 SW HIGHWAY 200
OCALA FL
34476-3976
US

V. Phone/Fax

Practice location:
  • Phone: 305-956-8729
  • Fax:
Mailing address:
  • Phone: 305-956-8729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS64986
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: