Provider Demographics
NPI:1760926430
Name:FAVERO-ORTIZ, KEVIN JAMES (MT(ASCP))
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JAMES
Last Name:FAVERO-ORTIZ
Suffix:
Gender:M
Credentials:MT(ASCP)
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:JAMES
Other - Last Name:FAVERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT(ASCP)
Mailing Address - Street 1:3663 S MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4237
Mailing Address - Country:US
Mailing Address - Phone:305-285-2981
Mailing Address - Fax:
Practice Address - Street 1:3663 S MIAMI AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4237
Practice Address - Country:US
Practice Address - Phone:305-285-2981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSU53146291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory