Healthcare Provider Details

I. General information

NPI: 1710277413
Provider Name (Legal Business Name): RUBEN PEREZ POLO ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18590 NW 67TH AVE STE 101
HIALEAH FL
33015-3540
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 400
MIAMI FL
33126-2051
US

V. Phone/Fax

Practice location:
  • Phone: 786-454-9850
  • Fax:
Mailing address:
  • Phone: 305-823-3312
  • Fax: 305-884-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9383647
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: