Provider Demographics
NPI:1942533997
Name:AREVALO SANTANA, LUBIN FERNANDO (MD)
Entity Type:Individual
Prefix:
First Name:LUBIN
Middle Name:FERNANDO
Last Name:AREVALO SANTANA
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 1:9500 S DADELAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2866
Mailing Address - Country:US
Mailing Address - Phone:305-468-4185
Mailing Address - Fax:
Practice Address - Street 1:7500 SW 87TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173
Practice Address - Country:US
Practice Address - Phone:305-913-0666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL32063207RG0100X
TXP7060207RG0100X
FLME135893207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology