Provider Demographics
NPI:1114958626
Name:GIRALDO, JUAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:P
Last Name:GIRALDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:660 GLADES RD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6465
Mailing Address - Country:US
Mailing Address - Phone:561-391-5515
Mailing Address - Fax:561-347-7470
Practice Address - Street 1:660 GLADES RD
Practice Address - Street 2:SUITE 460
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6465
Practice Address - Country:US
Practice Address - Phone:561-391-5515
Practice Address - Fax:561-347-7470
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA074411DO207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9024301Medicaid
NJH77033Medicare UPIN
NJ9024301Medicaid