Basic Information
| Provider Information | |||||||||
| NPI: | 1184163974 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRITO VILLALON | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | LAZARO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 351597 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331357597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054421740 | ||||||||
| FaxNumber: | 3054422207 | ||||||||
| Practice Location | |||||||||
| Address1: | 3825 W 16TH AVE | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330127005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552266633 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2017 | ||||||||
| LastUpdateDate: | 08/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 14050I | PR | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ACN961 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 208D00000X | ACN961 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.