Provider Demographics
NPI:1336475417
Name:BREA, JOSE ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:BREA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8825 NW 189TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6235
Mailing Address - Country:US
Mailing Address - Phone:786-376-2156
Mailing Address - Fax:305-884-3989
Practice Address - Street 1:8399 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6607
Practice Address - Country:US
Practice Address - Phone:954-518-6540
Practice Address - Fax:954-443-8035
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 111927207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine