MEDICARE: DR. JUAN LAZARO BRITO VILLALON M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	ME158777	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184163974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN LAZARO BRITO VILLALON M.D

Provider Business Mailing Address
First Line	:	PO BOX 351597
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-7597
Country	:	US
Telephone Number	:	305-442-1740
Fax Number	:	305-442-2207

Provider Business Practice Location Address
First Line	:	6400 SW 8TH ST
Second Line	:
City	:	WEST MIAMI
State	:	FL
Zip	:	33144-4814
Country	:	US
Telephone Number	:	305-587-2747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2017
Last Update Date	:	08/24/2023

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