Provider Demographics
NPI:1487606331
Name:PEREZ-ESPINOSA, JUAN CARLOS (DO)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:PEREZ-ESPINOSA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5780 SW 53RD TER
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6334
Mailing Address - Country:US
Mailing Address - Phone:305-444-3411
Mailing Address - Fax:
Practice Address - Street 1:3600 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1030
Practice Address - Country:US
Practice Address - Phone:305-444-3411
Practice Address - Fax:305-444-4113
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH95810Medicare UPIN
FL04261Medicare ID - Type Unspecified