Healthcare Provider Details

I. General information

NPI: 1134044589
Provider Name (Legal Business Name): JOHAN OZUNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 FAIRMOUNT PL
BRONX NY
10457-6405
US

IV. Provider business mailing address

2116 CROTONA PKWY APT 4D
BRONX NY
10460-1555
US

V. Phone/Fax

Practice location:
  • Phone: 718-731-3500
  • Fax:
Mailing address:
  • Phone: 929-334-8045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number42628
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: