Healthcare Provider Details

I. General information

NPI: 1467472449
Provider Name (Legal Business Name): JUAN J. FRIAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11501 SW 40TH ST
MIAMI FL
33165-3313
US

IV. Provider business mailing address

8600 NW 41ST ST
DORAL FL
33166-6202
US

V. Phone/Fax

Practice location:
  • Phone: 305-642-5366
  • Fax: 305-644-6407
Mailing address:
  • Phone: 305-642-5366
  • Fax: 305-644-6407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME101120
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number171223
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: