Healthcare Provider Details

I. General information

NPI: 1588757363
Provider Name (Legal Business Name): JUAN MESTRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

PO BOX 25750
MIAMI FL
33102-5750
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6618
  • Fax: 305-243-8470
Mailing address:
  • Phone: 305-243-6618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME96656
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: