Healthcare Provider Details

I. General information

NPI: 1790708022
Provider Name (Legal Business Name): JUAN C GIACHINO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 S KANNER HWY
STUART FL
34994-4622
US

IV. Provider business mailing address

2845 PGA BLVD
PALM BEACH GARDENS FL
33410-2910
US

V. Phone/Fax

Practice location:
  • Phone: 722-192-7777
  • Fax: 772-219-0017
Mailing address:
  • Phone: 772-283-8160
  • Fax: 772-283-8177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME86071
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: