Jose J Dergan P. a

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY4206 Issued in FL

Legal business name

JOSE J DERGAN P. A

Practice address

8249 NW 36TH St Ste 100
Doral, FL 33166-6673

Phone

(305) 599-1970

Fax

(305) 599-1971

NPI assigned

Nov 22, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lourdes Dergan

Title

Manager

Phone

(305) 599-1970

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Networks

• HealthSun Health Plans Network

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jose J Dergan, PSY.D

  • Clinical Psychologist
  • Doral, FL
  • NPI 1629160817
  Medicare reassignment NPD
• Mirta N Matos, PSY.D11/03/

  • Psychologist
  • Miami, FL
  • NPI 1912186040
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1290384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306195200000",
    "number": "1063714178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8249 NW 36TH ST STE 100",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331666673",
            "telephone_number": "305-599-1970",
            "fax_number": "305-599-1971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8249 NW 36TH ST STE 100",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331666673",
            "telephone_number": "305-599-1970",
            "fax_number": "305-599-1971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSE J DERGAN P. A",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-22",
        "last_updated": "2011-05-24",
        "status": "A",
        "authorized_official_last_name": "DERGAN",
        "authorized_official_first_name": "LOURDES",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "305-599-1970",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY4206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jalecia Johnson
• Larhonda Johnson
• Zoe Johnson, BCBA
• Jorge a. Soto PA
• Daniela Jorge Valdez
• Jose Medical Supplies Inc
• Jose Medical Supplies Inc
• Abigail B Joseph
• Christopher Joseph
• Fabiola Lamy Joseph, RBT

• Psychologist in Doral, FL
• Providers in Doral, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.