Provider Demographics
NPI:1912901497
Name:OCTAVIANI, HECTOR (MD)
Entity type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:
Last Name:OCTAVIANI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 REBECCA PL
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3070
Mailing Address - Country:US
Mailing Address - Phone:407-308-8509
Mailing Address - Fax:407-805-9757
Practice Address - Street 1:1577 REBECCA PL
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-3070
Practice Address - Country:US
Practice Address - Phone:407-308-8509
Practice Address - Fax:407-805-9757
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047365208000000X
FLME47365208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041746700Medicaid
FL041746700Medicaid
FL24922OtherWELLCARE
FL01109220OtherAMERIGROUP
D21808Medicare UPIN
FL59970OtherBC/BS