1215994132 NPI number — ARTURO RAFAEL LOGRONO

Table of content: ARTURO RAFAEL LOGRONO (NPI 1215994132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215994132 NPI number — ARTURO RAFAEL LOGRONO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOGRONO
Provider First Name:
ARTURO
Provider Middle Name:
RAFAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOGRONO
Provider Other First Name:
ARTURO
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1215994132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 SW 129 AVENUE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
PEMBROKE PINES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33027-1716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-430-9898
Provider Business Mailing Address Fax Number:
954-430-9677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 SW 129 AVENUE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
PEMBROKE PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33027-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-430-9898
Provider Business Practice Location Address Fax Number:
954-430-9677
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME74363 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 15909 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650959188 . This is a "VISTA SOUTH FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650959188 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 49588 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650959188 . This is a "VISTA HEALTH PLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 278273 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650959188 . This is a "TAX IDENTIFICATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 011159100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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