Healthcare Provider Details

I. General information

NPI: 1811929615
Provider Name (Legal Business Name): JAVIER ALBERTO HIRIART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15955 SW 96TH ST STE 200
MIAMI FL
33196-1272
US

IV. Provider business mailing address

PO BOX 198054
ATLANTA GA
30384-8054
US

V. Phone/Fax

Practice location:
  • Phone: 786-467-3140
  • Fax: 786-533-9276
Mailing address:
  • Phone: 786-467-3140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME 78742
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME78742
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: