Provider Demographics
NPI:1104019207
Name:ROBERTO AREVALO-ARAUJO MDPA
Entity type:Organization
Organization Name:ROBERTO AREVALO-ARAUJO MDPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:AREVALO ARAUJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-849-6690
Mailing Address - Street 1:3000 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-2635
Mailing Address - Country:US
Mailing Address - Phone:727-942-7070
Mailing Address - Fax:727-934-9457
Practice Address - Street 1:3000 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-2635
Practice Address - Country:US
Practice Address - Phone:727-942-7070
Practice Address - Fax:727-934-9457
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERTO AREVALO-ARAUJO MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-22
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062481100Medicaid
FL39020BMedicare PIN
CC2560Medicare PIN