Healthcare Provider Details

I. General information

NPI: 1437449295
Provider Name (Legal Business Name): ADRIANA CANTVILLE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 8TH ST
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

3609 BOONE PARK AVE
JACKSONVILLE FL
32205-9001
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-7474
  • Fax:
Mailing address:
  • Phone: 904-633-4199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS 12523
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: