Provider Demographics
NPI:1043224306
Name:JUAN ALBERTO PRIETO MD PA
Entity Type:Organization
Organization Name:JUAN ALBERTO PRIETO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:PRIETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-225-6462
Mailing Address - Street 1:14440 SW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-3121
Mailing Address - Country:US
Mailing Address - Phone:305-225-6462
Mailing Address - Fax:305-225-8239
Practice Address - Street 1:6741 CORAL WAY STE 50-51
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1762
Practice Address - Country:US
Practice Address - Phone:786-269-9495
Practice Address - Fax:305-225-8239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92259174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273626800Medicaid
FL273626800Medicaid