Healthcare Provider Details

I. General information

NPI: 1568886604
Provider Name (Legal Business Name): JAVIER EDUARDO MIRABAL ARROYO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

917 AVE TITO CASTRO STE 200-76
PONCE PR
00716-4717
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-8017
  • Fax:
Mailing address:
  • Phone: 787-692-3029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19639
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number19639
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number19639
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: