Provider Demographics
NPI:1548561186
Name:FUENTES GUERRA, JUAN MIGUEL (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:MIGUEL
Last Name:FUENTES GUERRA
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 1:7800 SW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6510
Mailing Address - Country:US
Mailing Address - Phone:786-231-8274
Mailing Address - Fax:
Practice Address - Street 1:7800 SW 21ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6510
Practice Address - Country:US
Practice Address - Phone:786-231-8274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-13
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1130312080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine