Healthcare Provider Details

I. General information

NPI: 1467442558
Provider Name (Legal Business Name): JUAN PABLO ZAMBRANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9380 SW 150TH ST SUITE 210
MIAMI FL
33176-7947
US

IV. Provider business mailing address

1500 NW 12TH AVE SUITE 810
MIAMI FL
33136-1051
US

V. Phone/Fax

Practice location:
  • Phone: 305-256-5018
  • Fax:
Mailing address:
  • Phone: 305-585-6649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME80831
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number80831
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: