MEDICARE: DR. JUAN R DEL RIO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME55089	FL
2	207R00000X	Internal Medicine Physician	ME0055089	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18746N	OTHER	FL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326023730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN R DEL RIO

Provider Business Mailing Address
First Line	:	PO BOX 4482
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-0482
Country	:	US
Telephone Number	:	786-506-9592
Fax Number	:	305-397-1825

Provider Business Practice Location Address
First Line	:	2001 W 68TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-1801
Country	:	US
Telephone Number	:	305-823-5000
Fax Number	:	305-397-1825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	07/22/2020

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