Provider Demographics
NPI:1114739513
Name:TERCERO, JOSUE DANIEL
Entity type:Individual
Prefix:
First Name:JOSUE
Middle Name:DANIEL
Last Name:TERCERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7873 W 36TH AVE UNIT 101
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7531
Mailing Address - Country:US
Mailing Address - Phone:786-985-0231
Mailing Address - Fax:
Practice Address - Street 1:7873 W 36TH AVE UNIT 101
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-7531
Practice Address - Country:US
Practice Address - Phone:786-985-0231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician