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General NPI Number Information
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NPI Number | 1154609246
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Entity Type | Individual
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Provider Name | JUAN M ANGEL MFT
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Gender | Male
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Dates
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Enumeration Date | 07/24/2011
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Last Update Date | 10/30/2019
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Provider Practice Location Address
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Address Line | 7001 SW 97TH AVE STE 208
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City | MIAMI
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State | FL
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Zip | 33173-1410
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Country | US
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Telephone | 954-648-9492
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Fax |
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Provider Business Mailing Address
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Address Line | 6001 SW 70TH ST APT 328
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-3429
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Country | US
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Telephone | 954-648-9492
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 103171
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT3719
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License Number State | FL
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