Provider Demographics
NPI:1538255146
Name:ENRIQUEZ, JUAN ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:ANTONIO
Last Name:ENRIQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4247 SW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1942
Mailing Address - Country:US
Mailing Address - Phone:305-398-8808
Mailing Address - Fax:
Practice Address - Street 1:237 NW 12TH AVE
Practice Address - Street 2:SUITE A-D
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33128
Practice Address - Country:US
Practice Address - Phone:305-324-0211
Practice Address - Fax:305-324-1015
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME63008OtherLICENSE HEALTH DEPARTMENT
FLME63008OtherLICENSE HEALTH DEPARTMENT
FLBE2888569OtherDEA
FLF69882Medicare UPIN