Provider Demographics
NPI:1689847568
Name:GALVEZ VARGAS, JUAN CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN CARLOS
Middle Name:
Last Name:GALVEZ VARGAS
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 1:3702 WASHINGTON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8283
Mailing Address - Country:US
Mailing Address - Phone:954-964-6114
Mailing Address - Fax:954-962-1994
Practice Address - Street 1:3702 WASHINGTON ST STE 202
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8283
Practice Address - Country:US
Practice Address - Phone:954-964-6114
Practice Address - Fax:954-962-1994
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128480207Q00000X
CAA119932207Q00000X
MN53001207Q00000X
FLME126491207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine