Healthcare Provider Details

I. General information

NPI: 1922278076
Provider Name (Legal Business Name): JUAN A BEREAO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 SW 166TH CT
MIAMI FL
33185-5149
US

IV. Provider business mailing address

PO BOX 650942
MIAMI FL
33265-0942
US

V. Phone/Fax

Practice location:
  • Phone: 305-251-3991
  • Fax: 305-251-7982
Mailing address:
  • Phone: 305-251-3991
  • 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: JUAN A BEREAO
Title or Position: MD
Credential:
Phone: 305-251-3991