Healthcare Provider Details

I. General information

NPI: 1073429072
Provider Name (Legal Business Name): JUAN MANUEL SOMARRIBA JARQUE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15311 SW 73RD TERRACE CIR APT 2
MIAMI FL
33193-1668
US

IV. Provider business mailing address

15311 SW 73RD TERRACE CIR APT 2
MIAMI FL
33193-1668
US

V. Phone/Fax

Practice location:
  • Phone: 786-867-6565
  • Fax:
Mailing address:
  • Phone: 786-867-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11049786
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: