Provider Demographics
NPI:1821003666
Name:ARVELO, GUSTAVO (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:
Last Name:ARVELO
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 1:308 W BASS ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5001
Mailing Address - Country:US
Mailing Address - Phone:407-933-1760
Mailing Address - Fax:407-933-8060
Practice Address - Street 1:308 W BASS ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5001
Practice Address - Country:US
Practice Address - Phone:407-933-1760
Practice Address - Fax:407-933-8060
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061187174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371274500Medicaid
FLF32379Medicare UPIN
FL371274500Medicaid