Healthcare Provider Details

I. General information

NPI: 1760329031
Provider Name (Legal Business Name): EXGLIS MARIBEL RIVAS CRASTO P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 NW 36TH ST APT 4604
DORAL FL
33178-3493
US

IV. Provider business mailing address

8800 NW 36TH ST APT 4604
DORAL FL
33178-3493
US

V. Phone/Fax

Practice location:
  • Phone: 786-301-8968
  • Fax:
Mailing address:
  • Phone: 786-301-8968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number21-342
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3160-P.A.
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3160-P.A.
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: