Individual
DR. JOSE J DERGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D
Contact information
Practice address
8249 NW 36TH ST STE 102, DORAL, FL 33166-6673
(305) 599-1970
(305) 599-1971
Mailing address
8249 NW 36TH ST STE 102, DORAL, FL 33166-6673
(305) 599-1970
(305) 599-1971
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY 004206
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
210099100
—
FL
01
—
65-0167578
TAX IDENTIFICATION
FL
Enumeration date
09/28/2006
Last updated
11/22/2010
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