MEDICARE: DR. JUAN B ESPINOSA PACC MD

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	2084P0800X	Psychiatry Physician	ME0027377	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00002544	OTHER		RAIL ROAD MEDICARE

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750381026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN B ESPINOSA PACC MD

Provider Business Mailing Address
First Line	:	17501 BISCAYNE BLVD
Second Line	:	SUITE 340
City	:	AVENTURA
State	:	FL
Zip	:	33160-4802
Country	:	US
Telephone Number	:	305-935-3344
Fax Number	:	305-935-3955

Provider Business Practice Location Address
First Line	:	17501 BISCAYNE BLVD
Second Line	:	SUITE 340
City	:	AVENTURA
State	:	FL
Zip	:	33160-4802
Country	:	US
Telephone Number	:	305-935-3344
Fax Number	:	305-935-3955

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	09/06/2012

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Directions to “ DR. JUAN B ESPINOSA PACC MD” Practice Location

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