Healthcare Provider Details

I. General information

NPI: 1023085065
Provider Name (Legal Business Name): JUAN FICA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1389 W MAIN ST TOWER 2, SUITE 320
WATERBURY CT
06708-3104
US

IV. Provider business mailing address

1389 W MAIN ST TOWER 2, SUITE 320
WATERBURY CT
06708-3104
US

V. Phone/Fax

Practice location:
  • Phone: 203-753-9313
  • Fax: 203-573-8976
Mailing address:
  • Phone: 203-753-9313
  • Fax: 203-573-8976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number020699
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number020699
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: