Healthcare Provider Details

I. General information

NPI: 1518135300
Provider Name (Legal Business Name): ROYAL PALM ORTHOPEDIC & SPORTS MEDICINE INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 CARLTON AVE STE 1400
LAKE WALES FL
33853-4347
US

IV. Provider business mailing address

23781 US HIGHWAY 27 SUITE 122
LAKE WALES FL
33859-7802
US

V. Phone/Fax

Practice location:
  • Phone: 863-324-6100
  • Fax: 863-679-9182
Mailing address:
  • Phone: 863-324-6100
  • Fax: 863-679-9182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME64942
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME64942
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID ARANGO
Title or Position: PHYSICIAN
Credential: MD
Phone: 863-324-6100