=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992249023
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUAN A PRIETO INPATIENT PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2016
-----------------------------------------------------
Last Update Date | 12/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4191 EL PRADO BLVD
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33133-6311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-269-9495
-----------------------------------------------------
Fax | 305-269-7377
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4191 EL PRADO BLVD
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33133-6311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-269-9495
-----------------------------------------------------
Fax | 305-269-7377
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSTD
-----------------------------------------------------
Name | JUAN A PRIETO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 786-269-9495
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------