Provider Demographics
NPI:1710930474
Name:JUAN CARLOS RONDON MD PA
Entity Type:Organization
Organization Name:JUAN CARLOS RONDON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:RONDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-322-8985
Mailing Address - Street 1:3157 N UNIVERSITY DR SUITE 103
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3623
Mailing Address - Country:US
Mailing Address - Phone:954-322-8985
Mailing Address - Fax:954-322-8981
Practice Address - Street 1:3157 N UNIVERSITY DR STE 103
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2258
Practice Address - Country:US
Practice Address - Phone:954-322-8985
Practice Address - Fax:954-322-8981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2024-03-22
Deactivation Date:2023-09-01
Deactivation Code:
Reactivation Date:2024-03-19
Provider Licenses
StateLicense IDTaxonomies
FLME79915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258851000Medicaid
FLAK238Medicare PIN
FLH15457Medicare UPIN