Basic Information
| Provider Information | |||||||||
| NPI: | 1003312232 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RONDEAU | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | CRISTOBAL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7000 SW 62ND AVE STE 401 | ||||||||
| Address2: | |||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331434721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548923851 | ||||||||
| FaxNumber: | 3052847787 | ||||||||
| Practice Location | |||||||||
| Address1: | 17422 SW 74TH CT | ||||||||
| Address2: | |||||||||
| City: | PALMETTO BAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331576341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548923851 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2018 | ||||||||
| LastUpdateDate: | 04/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 147585 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 147585 | 01 | FL | FLORIDA BOARD OF MEDICINE | OTHER |