Provider Demographics
NPI:1720419443
Name:JATIVA, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:JATIVA
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 1:14358 BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-1206
Mailing Address - Country:US
Mailing Address - Phone:305-912-4039
Mailing Address - Fax:305-909-9686
Practice Address - Street 1:14358 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181
Practice Address - Country:US
Practice Address - Phone:305-912-4039
Practice Address - Fax:305-909-9686
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126406207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine