Provider Demographics
NPI:1457043093
Name:PANTOJA MIRANDA, JUAN CARLOS (MD, CSFA, CCMA)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:PANTOJA MIRANDA
Suffix:
Gender:
Credentials:MD, CSFA, CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 BRICKELL BAY DR APT 1608
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2932
Mailing Address - Country:US
Mailing Address - Phone:754-301-1696
Mailing Address - Fax:
Practice Address - Street 1:2320 NE 9TH ST STE 300
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3590
Practice Address - Country:US
Practice Address - Phone:954-563-4500
Practice Address - Fax:954-530-0399
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
WI23-396246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty