Healthcare Provider Details

I. General information

NPI: 1164125050
Provider Name (Legal Business Name): JAVIER ENRIQUE CANAHUATI ESCOBAR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18600 FERNVIEW ST
LAND O LAKES FL
34638-6212
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 813-692-8050
  • Fax: 813-605-6184
Mailing address:
  • Phone: 727-532-0002
  • Fax: 727-333-6504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS23437
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: