Healthcare Provider Details

I. General information

NPI: 1255546669
Provider Name (Legal Business Name): JC FLEITES MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3661 S MIAMI AVE SUITE 708
MIAMI FL
33133-4236
US

IV. Provider business mailing address

3661 S MIAMI AVE SUITE 708
MIAMI FL
33133-4236
US

V. Phone/Fax

Practice location:
  • Phone: 305-856-1002
  • Fax: 305-856-0199
Mailing address:
  • Phone: 305-856-1002
  • Fax: 305-856-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME0070014
License Number StateFL

VIII. Authorized Official

Name: DR. JUAN C FLEITES
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 305-856-1002