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General NPI Number Information
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NPI Number | 1538255146
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Entity Type | Individual
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Provider Name | JUAN ANTONIO ENRIQUEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 237 NW 12TH AVE SUITE A-D
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City | MIAMI
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State | FL
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Zip | 33128
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Country | US
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Telephone | 305-324-0211
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Fax | 305-324-1015
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Provider Business Mailing Address
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Address Line | 4247 SW 5TH ST
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City | MIAMI
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State | FL
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Zip | 33134-1942
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Country | US
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Telephone | 305-398-8808
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME63008
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License Number State | FL
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