Provider Demographics
NPI:1538207436
Name:JUAN B ESPINOSA MD PA
Entity type:Organization
Organization Name:JUAN B ESPINOSA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ESPINOSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-935-3344
Mailing Address - Street 1:17501 BISCAYNE BLVD
Mailing Address - Street 2:SUITE #340
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4802
Mailing Address - Country:US
Mailing Address - Phone:305-935-3344
Mailing Address - Fax:305-935-3955
Practice Address - Street 1:17501 BISCAYNE BLVD
Practice Address - Street 2:SUITE #340
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-4802
Practice Address - Country:US
Practice Address - Phone:305-935-3344
Practice Address - Fax:305-935-3955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAE7161805332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037528400Medicaid
FL037528400Medicaid
FL95071Medicare PIN