Healthcare Provider Details

I. General information

NPI: 1043269863
Provider Name (Legal Business Name): JUAN C ABREU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 49TH ST
HIALEAH FL
33012-3714
US

IV. Provider business mailing address

200 W 49TH ST
HIALEAH FL
33012-3714
US

V. Phone/Fax

Practice location:
  • Phone: 786-273-1361
  • Fax: 305-851-4137
Mailing address:
  • Phone: 786-273-1361
  • Fax: 305-851-4137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME84810
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME84810
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: