Healthcare Provider Details

I. General information

NPI: 1174914089
Provider Name (Legal Business Name): ANGEL T JUNQUERA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12749 SW 42ND ST
MIAMI FL
33175-3429
US

IV. Provider business mailing address

12749 SW 42ND ST
MIAMI FL
33175-3429
US

V. Phone/Fax

Practice location:
  • Phone: 305-226-1008
  • Fax:
Mailing address:
  • Phone: 305-226-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0045656
License Number StateFL

VIII. Authorized Official

Name: LHYVANN FELIPE
Title or Position: BILLING MANAGER
Credential:
Phone: 305-598-9096