Healthcare Provider Details

I. General information

NPI: 1407226277
Provider Name (Legal Business Name): KRYPTON MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 12/24/2021
Certification Date: 12/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10771 SW 64TH ST
MIAMI FL
33173-2022
US

IV. Provider business mailing address

10771 SW 64TH ST
MIAMI FL
33173-2022
US

V. Phone/Fax

Practice location:
  • Phone: 305-301-3693
  • Fax: 305-553-5271
Mailing address:
  • Phone: 305-301-3693
  • Fax: 305-553-5271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9337727
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP9337727
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP9337727
License Number StateFL

VIII. Authorized Official

Name: DAVID JOSE TRABANCO
Title or Position: NURSE PRACTITIONER/OWNER
Credential: ARNP, AGNP, NP-C
Phone: 305-301-3693