Healthcare Provider Details

I. General information

NPI: 1811011588
Provider Name (Legal Business Name): JUAN C QUEROL MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 NW 151ST ST SUITE 306
MIAMI LAKES FL
33014-2476
US

IV. Provider business mailing address

PO BOX 172286
HIALEAH FL
33017-2286
US

V. Phone/Fax

Practice location:
  • Phone: 305-698-0452
  • Fax: 305-698-0476
Mailing address:
  • Phone: 305-698-0452
  • Fax: 305-698-0476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME68841
License Number StateFL

VIII. Authorized Official

Name: DR. JUAN C QUEROL
Title or Position: MDPA
Credential: M.D
Phone: 305-698-0452