Healthcare Provider Details

I. General information

NPI: 1619471935
Provider Name (Legal Business Name): RUBEN EMANUEL CENDAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 JFK DR STE 210
ATLANTIS FL
33462-6641
US

IV. Provider business mailing address

5301 S CONGRESS AVE
ATLANTIS FL
33462-1149
US

V. Phone/Fax

Practice location:
  • Phone: 561-548-1450
  • Fax: 561-548-1459
Mailing address:
  • Phone: 561-548-1273
  • Fax: 561-548-1572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS17356
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: