Provider Demographics
NPI:1225472756
Name:JUAN O SEJAS LLC
Entity Type:Organization
Organization Name:JUAN O SEJAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:SEJAS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:305-915-0659
Mailing Address - Street 1:7911 NW 72ND AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33166-2227
Mailing Address - Country:US
Mailing Address - Phone:305-915-0659
Mailing Address - Fax:
Practice Address - Street 1:19550 NE 26TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-2205
Practice Address - Country:US
Practice Address - Phone:305-915-0659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9300064207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty