Provider Demographics
NPI:1467442558
Name:ZAMBRANO, JUAN PABLO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:PABLO
Last Name:ZAMBRANO
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 1:1500 NW 12TH AVE
Mailing Address - Street 2:SUITE 810
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1051
Mailing Address - Country:US
Mailing Address - Phone:305-585-6649
Mailing Address - Fax:
Practice Address - Street 1:9380 SW 150TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7947
Practice Address - Country:US
Practice Address - Phone:305-256-5018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80831207RC0000X
FL80831207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2723158Medicaid
FL01577OtherBCBS
FL51742OtherNHP
FL01577OtherBCBS
FL2723158Medicaid