Provider Demographics
NPI:1114023827
Name:JUAN R DEL RIO MD PA
Entity Type:Organization
Organization Name:JUAN R DEL RIO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:ROSBALDO
Authorized Official - Last Name:DEL RIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-506-9592
Mailing Address - Street 1:PO BOX 4482
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-0482
Mailing Address - Country:US
Mailing Address - Phone:786-506-9592
Mailing Address - Fax:305-397-1825
Practice Address - Street 1:2001 W 68TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1801
Practice Address - Country:US
Practice Address - Phone:305-823-5000
Practice Address - Fax:305-397-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373476500Medicaid
FLAA167OtherMEDICARE GROUP
FLAA167OtherMEDICARE GROUP
FLF55102Medicare UPIN