Provider Demographics
NPI:1790013126
Name:ROBERTO AREVALO-ARAUJO MD PA
Entity Type:Organization
Organization Name:ROBERTO AREVALO-ARAUJO MD PA
Other - Org Name:CANCER CENTER OF PASCO PINELLAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:AREVALO ARAUJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-849-6690
Mailing Address - Street 1:3000 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-2635
Mailing Address - Country:US
Mailing Address - Phone:727-849-6690
Mailing Address - Fax:727-848-3771
Practice Address - Street 1:1744 S PINELLAS AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-1939
Practice Address - Country:US
Practice Address - Phone:727-942-1259
Practice Address - Fax:727-942-8628
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERTO AREVALO-ARAUJO MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-23
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371622800Medicaid
CE9653Medicare PIN
FL39020AMedicare PIN