Healthcare Provider Details

I. General information

NPI: 1992878144
Provider Name (Legal Business Name): JUSTO CARLOS FELIPE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4526 PALM AVE
HIALEAH FL
33012-4034
US

IV. Provider business mailing address

4526 PALM AVE
HIALEAH FL
33012-4034
US

V. Phone/Fax

Practice location:
  • Phone: 786-600-7560
  • Fax: 786-648-5503
Mailing address:
  • Phone: 786-600-7560
  • Fax: 786-648-5503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME65902
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME65902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: