Provider Demographics
NPI:1518133867
Name:RECABARREN VELARDE, JUANA SOFIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JUANA
Middle Name:SOFIA
Last Name:RECABARREN VELARDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4780 SW 64TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4400
Mailing Address - Country:US
Mailing Address - Phone:954-434-1705
Mailing Address - Fax:800-642-2398
Practice Address - Street 1:1604 TOWN CENTER BLVD
Practice Address - Street 2:SUITE 4C
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326
Practice Address - Country:US
Practice Address - Phone:954-384-1800
Practice Address - Fax:954-384-1802
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME113380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007256000Medicaid
FLL3065OtherMEDICARE