Provider Demographics
NPI:1124197009
Name:MERUELO, HECTOR JOAQUIN (MD)
Entity Type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:JOAQUIN
Last Name:MERUELO
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 1:777 E 25TH ST
Mailing Address - Street 2:502
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3825
Mailing Address - Country:US
Mailing Address - Phone:305-836-7377
Mailing Address - Fax:305-836-9537
Practice Address - Street 1:777 E 25TH ST
Practice Address - Street 2:502
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3825
Practice Address - Country:US
Practice Address - Phone:305-836-7377
Practice Address - Fax:305-836-9537
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME20841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME20841OtherMEDICAL LICENSE NUMBER
FL591941295OtherTAX IDENTIFICATION NUMBER
FL057381700Medicaid
FL92223Medicare ID - Type UnspecifiedMEDICARE
FL057381700Medicaid