Provider Demographics
NPI:1215994132
Name:LOGRONO, ARTURO RAFAEL
Entity type:Individual
Prefix:
First Name:ARTURO
Middle Name:RAFAEL
Last Name:LOGRONO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ARTURO
Other - Middle Name:
Other - Last Name:LOGRONO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1 SW 129 AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1716
Mailing Address - Country:US
Mailing Address - Phone:954-430-9898
Mailing Address - Fax:954-430-9677
Practice Address - Street 1:1 SW 129 AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1716
Practice Address - Country:US
Practice Address - Phone:954-430-9898
Practice Address - Fax:954-430-9677
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74363207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15909OtherAETNA
FL650959188OtherVISTA SOUTH FLORIDA
FL650959188OtherCIGNA
FL49588OtherBLUE CROSS & BLUE SHIELD
FL650959188OtherVISTA HEALTH PLAN
FL278273OtherAVMED
FL650959188OtherTAX IDENTIFICATION
FL650959188OtherVISTA SOUTH FLORIDA
FL650959188OtherVISTA HEALTH PLAN
FL15909OtherAETNA