Healthcare Provider Details

I. General information

NPI: 1023234507
Provider Name (Legal Business Name): JUAN A BEREAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8352 SW 8TH ST
MIAMI FL
33144-4180
US

IV. Provider business mailing address

PO BOX 650942
MIAMI FL
33265-0942
US

V. Phone/Fax

Practice location:
  • Phone: 305-262-8282
  • Fax:
Mailing address:
  • Phone: 305-262-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME97447
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: