Healthcare Provider Details

I. General information

NPI: 1508234360
Provider Name (Legal Business Name): JUAN CARLOS ABREU, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 09/10/2015
Certification Date:
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 TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME84810
License Number StateFL

VIII. Authorized Official

Name: JUAN C ABREU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 786-273-1361