MEDICARE: MR. JUANA TRELLES SLP

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	235Z00000X	Speech-Language Pathologist	SA 3924	FL

General Provider Information

NPI Number	:	1558398073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUANA TRELLES SLP

Provider Business Mailing Address
First Line	:	7725 GRANDVIEW BLVD
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-6419
Country	:	US
Telephone Number	:	305-562-5113
Fax Number	:	954-341-7895

Provider Business Practice Location Address
First Line	:	9900 W SAMPLE RD
Second Line	:	SUITE 102
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4048
Country	:	US
Telephone Number	:	954-341-7875
Fax Number	:	954-341-7895

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. JUANA TRELLES SLP” Practice Location

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