Provider Demographics
NPI:1144529827
Name:VICENTE A. CHAVARRIA M.D. P.A.
Entity type:Organization
Organization Name:VICENTE A. CHAVARRIA M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICENTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-670-7006
Mailing Address - Street 1:10700 N KENDALL DR STE 304
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1469
Mailing Address - Country:US
Mailing Address - Phone:305-670-7006
Mailing Address - Fax:305-670-7806
Practice Address - Street 1:10700 N KENDALL DR STE 304
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1469
Practice Address - Country:US
Practice Address - Phone:305-670-7006
Practice Address - Fax:305-670-7806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2500X
FLME 60493261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375946601Medicaid
25753OtherMEDICARE NUMBER
FL375946601Medicaid