Provider Demographics
NPI:1952549149
Name:HUMBERTO G JUNCO M D P A
Entity type:Organization
Organization Name:HUMBERTO G JUNCO M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:G
Authorized Official - Last Name:JUNCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PA
Authorized Official - Phone:305-273-0228
Mailing Address - Street 1:7000 SW 97TH AVE
Mailing Address - Street 2:115
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1494
Mailing Address - Country:US
Mailing Address - Phone:305-273-0228
Mailing Address - Fax:305-273-5488
Practice Address - Street 1:7000 SW 97TH AVE
Practice Address - Street 2:115
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1494
Practice Address - Country:US
Practice Address - Phone:305-273-0228
Practice Address - Fax:305-273-5488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27473174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268788700Medicaid
FL268788700Medicaid
FL95994Medicare PIN