Healthcare Provider Details

I. General information

NPI: 1609820968
Provider Name (Legal Business Name): JUAN FRANCISCO FALLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 01/11/2026
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PINE AVENUE NORTH
OLDSMAR FL
34677-4629
US

IV. Provider business mailing address

120 PINE AVE N
OLDSMAR FL
34677-4629
US

V. Phone/Fax

Practice location:
  • Phone: 813-814-9504
  • Fax: 813-635-7946
Mailing address:
  • Phone: 813-814-9504
  • Fax: 813-635-7946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME53878
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: