Provider Demographics
NPI:1831169630
Name:VERDEJA, RABAZA & GONZALEZ, MD, PA
Entity type:Organization
Organization Name:VERDEJA, RABAZA & GONZALEZ, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN-CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:VERDEJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-271-9777
Mailing Address - Street 1:7800 SW 87TH AVE
Mailing Address - Street 2:STE B-210
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3570
Mailing Address - Country:US
Mailing Address - Phone:305-271-9777
Mailing Address - Fax:305-595-9590
Practice Address - Street 1:7800 SW 87TH AVE
Practice Address - Street 2:STE B-210
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3570
Practice Address - Country:US
Practice Address - Phone:305-271-9777
Practice Address - Fax:305-595-9590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL367985-0174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24143Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
FLW99090Medicare UPIN