Healthcare Provider Details

I. General information

NPI: 1447699806
Provider Name (Legal Business Name): JUAN DIEGO MEJIA OTERO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JUAN D MEJIA-OTERO MD

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10383 HAGEN RANCH RD STE 200
BOYNTON BEACH FL
33437-3782
US

IV. Provider business mailing address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

V. Phone/Fax

Practice location:
  • Phone: 561-799-7272
  • Fax: 561-799-7274
Mailing address:
  • Phone: 305-662-8357
  • Fax: 305-669-6406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberE-11903
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberME164731
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: