Healthcare Provider Details

I. General information

NPI: 1538207436
Provider Name (Legal Business Name): JUAN B ESPINOSA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17501 BISCAYNE BLVD SUITE #340
AVENTURA FL
33160-4802
US

IV. Provider business mailing address

17501 BISCAYNE BLVD SUITE #340
AVENTURA FL
33160-4802
US

V. Phone/Fax

Practice location:
  • Phone: 305-935-3344
  • Fax: 305-935-3955
Mailing address:
  • Phone: 305-935-3344
  • Fax: 305-935-3955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberAE7161805
License Number StateFL

VIII. Authorized Official

Name: DR. JUAN B ESPINOSA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 305-935-3344