Provider Demographics
NPI:1760459986
Name:SEVILLA, XAVIER DIEGO (MD)
Entity Type:Individual
Prefix:
First Name:XAVIER
Middle Name:DIEGO
Last Name:SEVILLA
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 1:2995 DREW ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-315-7496
Mailing Address - Fax:
Practice Address - Street 1:712 39TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205
Practice Address - Country:US
Practice Address - Phone:941-748-4602
Practice Address - Fax:941-747-9230
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076653208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28272OtherWELLCARE
FL47209OtherBCBS
FL301386OtherWELLCARE URGENT CARE
FL229615OtherAMERIGROUP URGENT CARE
FL191852OtherAMERIGROUP
FL1200274OtherUNITED HEALTHCARE
FL28272OtherWELLCARE
FL191852OtherAMERIGROUP
FL229615OtherAMERIGROUP URGENT CARE
FL47209OtherBCBS
FLP102231OtherFREEDOM HEALTH
FL47209ZMedicare ID - Type Unspecified