Healthcare Provider Details

I. General information

NPI: 1215154943
Provider Name (Legal Business Name): JUAN CARLOS MENESES PAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE MIAMI CHILDREN'S HOSPITAL
MIAMI FL
33155-3009
US

IV. Provider business mailing address

3100 SW 62ND AVE MIAMI CHILDREN'S HOSPITAL
MIAMI FL
33155-3009
US

V. Phone/Fax

Practice location:
  • Phone: 305-663-6890
  • Fax: 305-669-6501
Mailing address:
  • Phone: 305-663-6890
  • Fax: 305-669-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number036.130273
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME 102340
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME102340
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: