Provider Demographics
NPI:1942442538
Name:GONZALEZ HERRAN, JUAN MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:MANUEL
Last Name:GONZALEZ HERRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2771 EXECUTIVE PARK DR STE 1
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3643
Mailing Address - Country:US
Mailing Address - Phone:754-348-3899
Mailing Address - Fax:888-571-6330
Practice Address - Street 1:2771 EXECUTIVE PARK DR STE 1
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3643
Practice Address - Country:US
Practice Address - Phone:754-348-3899
Practice Address - Fax:888-571-6330
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239550208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110084121AMedicaid
MA110084121AMedicaid