Provider Demographics
NPI:1518992106
Name:INOCENTES, ARIEL (MD)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:INOCENTES
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 1:12596 NW 67TH DR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-1961
Mailing Address - Country:US
Mailing Address - Phone:954-340-7041
Mailing Address - Fax:954-340-7041
Practice Address - Street 1:12596 NW 67TH DR
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-1961
Practice Address - Country:US
Practice Address - Phone:954-340-7041
Practice Address - Fax:954-340-7041
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69193208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
F85877Medicare UPIN
FL49309Medicare ID - Type Unspecified