Provider Demographics
NPI:1326023730
Name:DEL RIO, JUAN R
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:R
Last Name:DEL RIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55089174400000X
FLME0055089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18746NOtherMEDICARE PTAN
FL373476500Medicaid
FL373476500Medicaid