Provider Demographics
NPI:1558551135
Name:PEREDA, JUAN CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:JUAN CARLOS
Middle Name:
Last Name:PEREDA
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 1:6200 SUNSET DR
Mailing Address - Street 2:SUITE 505
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4830
Mailing Address - Country:US
Mailing Address - Phone:305-668-1660
Mailing Address - Fax:305-668-1650
Practice Address - Street 1:6200 SUNSET DR
Practice Address - Street 2:SUITE 505
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4828
Practice Address - Country:US
Practice Address - Phone:305-668-1660
Practice Address - Fax:305-668-1650
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME995842086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06318Medicare PIN
FLAE182ZMedicare PIN