Provider Demographics
NPI:1871338566
Name:JOURNO, RUBEN YOSSEF MOCHE
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:YOSSEF MOCHE
Last Name:JOURNO
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 1:4779 COLLINS AVE APT 3307
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3259
Mailing Address - Country:US
Mailing Address - Phone:786-630-5152
Mailing Address - Fax:
Practice Address - Street 1:4779 COLLINS AVE APT 3307
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3259
Practice Address - Country:US
Practice Address - Phone:786-630-5152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN29241122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist