Healthcare Provider Details

I. General information

NPI: 1518133867
Provider Name (Legal Business Name): JUANA SOFIA RECABARREN VELARDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 TOWN CENTER BLVD SUITE 4C
WESTON FL
33326
US

IV. Provider business mailing address

4780 SW 64TH AVE STE 103
DAVIE FL
33314-4400
US

V. Phone/Fax

Practice location:
  • Phone: 954-384-1800
  • Fax: 954-384-1802
Mailing address:
  • Phone: 954-434-1705
  • Fax: 800-642-2398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME113380
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: