Healthcare Provider Details

I. General information

NPI: 1033452677
Provider Name (Legal Business Name): JUAN SERRALLES ALLONGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JUAN SERRALLES MD

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-1960
  • Fax: 305-243-5546
Mailing address:
  • Phone: 305-243-1960
  • Fax: 305-243-5546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME126983
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME126983
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: