Provider Demographics
NPI:1598565194
Name:DE JUAN, CARMEN E
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:E
Last Name:DE JUAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11662 NW 89TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4153
Mailing Address - Country:US
Mailing Address - Phone:305-834-6267
Mailing Address - Fax:
Practice Address - Street 1:2711 SW 137TH AVE STE 98
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6361
Practice Address - Country:US
Practice Address - Phone:786-665-6765
Practice Address - Fax:786-807-7337
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ12538235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty