Provider Demographics
NPI:1447699806
Name:MEJIA OTERO, JUAN DIEGO (MD)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:DIEGO
Last Name:MEJIA OTERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:D
Other - Last Name:MEJIA-OTERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3100 SW 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:305-662-8357
Mailing Address - Fax:305-669-6406
Practice Address - Street 1:10383 HAGEN RANCH RD STE 200
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3782
Practice Address - Country:US
Practice Address - Phone:561-799-7272
Practice Address - Fax:561-799-7274
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-119032080P0205X
FLME1647312080P0205X
FL1647312080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology