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General NPI Number Information
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NPI Number | 1982080099
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Entity Type | Individual
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Provider Name | JUAN CARLOS DE ARREDONDO DIAZ FNP
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Gender | Male
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Dates
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Enumeration Date | 07/31/2015
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 3663 S MIAMI AVE
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City | MIAMI
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State | FL
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Zip | 33133-4253
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Country | US
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Telephone | 305-856-3338
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Fax |
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Provider Business Mailing Address
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Address Line | 11102 NW 83RD ST APT 230
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City | DORAL
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State | FL
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Zip | 33178-1742
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Country | US
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Telephone | 305-890-8763
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 13-573
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11006151
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License Number State | FL
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