Provider Demographics
NPI:1932308996
Name:MIRABA;, JUAN D (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:D
Last Name:MIRABA;
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 1:4483 NW 36TH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7260
Mailing Address - Country:US
Mailing Address - Phone:305-888-7555
Mailing Address - Fax:305-888-7410
Practice Address - Street 1:1448 N KROME AVE
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-2401
Practice Address - Country:US
Practice Address - Phone:305-245-0222
Practice Address - Fax:305-245-6212
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 67719207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice