Provider Demographics
NPI:1225596851
Name:ARRIETA FLOREZ, PEDRO JOSE (SA-C)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:JOSE
Last Name:ARRIETA FLOREZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 NW 114TH AVE UNIT 107
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3574
Mailing Address - Country:US
Mailing Address - Phone:305-814-0661
Mailing Address - Fax:
Practice Address - Street 1:5250 NW 114TH AVE UNIT 107
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-3574
Practice Address - Country:US
Practice Address - Phone:305-814-0661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-02
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19-131246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant