Provider Demographics
NPI:1376554725
Name:ARENCIBIA, GUILLERMO (OD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:
Last Name:ARENCIBIA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13818 SW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6061
Mailing Address - Country:US
Mailing Address - Phone:305-382-2424
Mailing Address - Fax:305-382-2428
Practice Address - Street 1:13818 SW 56TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6061
Practice Address - Country:US
Practice Address - Phone:305-382-2424
Practice Address - Fax:305-382-2428
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3686152W00000X
FLOPC 3686152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL201861049OtherVISION CARE PLAN-VCP
FLOE26777OtherSPECTERA
FL2157OtherSUPERIOR
FLFL3686OtherEYEMED
FL201861049OtherPRIMARY PLUS
FL621008200Medicaid
FL50887OtherDAVIS VISION
FLAH384Medicare PIN