Provider Demographics
NPI:1528052388
Name:ARRIETA, AGUSTIN JAVIER (MD)
Entity type:Individual
Prefix:
First Name:AGUSTIN
Middle Name:JAVIER
Last Name:ARRIETA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15280 NW 79TH CT STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5873
Mailing Address - Country:US
Mailing Address - Phone:305-558-3724
Mailing Address - Fax:786-907-4485
Practice Address - Street 1:15955 SW 96TH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1271
Practice Address - Country:US
Practice Address - Phone:305-380-6773
Practice Address - Fax:786-533-1680
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92547207YP0228X, 207YS0012X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276031200Medicaid
FLI34730Medicare UPIN
FLU5110ZMedicare ID - Type Unspecified