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NPI Code Detail

MEDICARE: JUAN CHAVES ETC

MEDICARE: JUAN CHAVES ETC
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
1170100000XPh.D. Medical GeneticsMA44479FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MA44479OTHERFLCLINIC/CENTER- HEALTH SERVICES

General Provider Information

NPI Number : 1457682221
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUAN CHAVES ETC
Provider Business Mailing Address
First Line : 4545 NW 7TH ST
Second Line : SUITE # 15-16
City : MIAMI
State : FL
Zip : 33126-2300
Country : US
Telephone Number : 305-460-9945
Fax Number : 305-460-9947
Provider Business Practice Location Address
First Line : 4545 NW 7TH ST
Second Line : SUITE # 15-16
City : MIAMI
State : FL
Zip : 33126-2300
Country : US
Telephone Number : 305-460-9945
Fax Number : 305-460-9947
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2010
Last Update Date : 01/19/2010

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Directions to “ JUAN CHAVES ETC” Practice Location

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