Provider Demographics
NPI:1003312232
Name:RONDEAU, JUAN CRISTOBAL (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CRISTOBAL
Last Name:RONDEAU
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 1:7000 SW 62ND AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4721
Mailing Address - Country:US
Mailing Address - Phone:954-892-3851
Mailing Address - Fax:305-284-7787
Practice Address - Street 1:17422 SW 74TH CT
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6341
Practice Address - Country:US
Practice Address - Phone:954-892-3851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1475852084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL147585OtherFLORIDA BOARD OF MEDICINE