Healthcare Provider Details

I. General information

NPI: 1245292374
Provider Name (Legal Business Name): JUAN CARLOS QUEROL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8212 W FLAGLER ST
MIAMI FL
33144-2028
US

IV. Provider business mailing address

PO BOX 172286
HIALEAH FL
33017-2286
US

V. Phone/Fax

Practice location:
  • Phone: 305-822-3475
  • Fax:
Mailing address:
  • Phone: 305-822-3475
  • Fax:

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:
Title or Position:
Credential:
Phone: