Healthcare Provider Details

I. General information

NPI: 1356304885
Provider Name (Legal Business Name): JULIO CESAR EGUSQUIZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W 20TH AVE SUITE 411
HIALEAH FL
33016-1897
US

IV. Provider business mailing address

3220 SW 107TH AVE
MIAMI FL
33165-3606
US

V. Phone/Fax

Practice location:
  • Phone: 305-823-0901
  • Fax: 305-558-5304
Mailing address:
  • Phone: 305-551-1195
  • Fax: 305-551-1094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME54356
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: