Healthcare Provider Details

I. General information

NPI: 1962443036
Provider Name (Legal Business Name): JOSEPH RAUL TRIANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3661 S MIAMI AVE SUITE704
MIAMI FL
33133-4236
US

IV. Provider business mailing address

3661 S MIAMI AVE SUITE 704
MIAMI FL
33133-4236
US

V. Phone/Fax

Practice location:
  • Phone: 305-854-8112
  • Fax: 305-854-1633
Mailing address:
  • Phone: 305-854-8112
  • Fax: 305-854-1633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME86888
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: