Healthcare Provider Details

I. General information

NPI: 1790106805
Provider Name (Legal Business Name): ELESBAN ALVERO PROENZA ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11255 SW 211TH ST AMERICAN CARE OF SOUTH FLORIDA, INC.
MIAMI FL
33189-2240
US

IV. Provider business mailing address

11255 SW 211TH ST AMERICAN CARE OF SOUTH FLORIDA, INC.
MIAMI FL
33189-2240
US

V. Phone/Fax

Practice location:
  • Phone: 305-278-0200
  • Fax: 786-235-0145
Mailing address:
  • Phone: 305-278-0200
  • Fax: 786-235-0145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP-9338500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: