Provider Demographics
NPI:1669197901
Name:ARISMENDY ENRIQUE MEDICAL ENTERPRISES INC
Entity type:Organization
Organization Name:ARISMENDY ENRIQUE MEDICAL ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARISMENDY
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:PEREZ-TAVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-900-1326
Mailing Address - Street 1:4600 CALATRAVA AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-1962
Mailing Address - Country:US
Mailing Address - Phone:786-918-6462
Mailing Address - Fax:727-954-6546
Practice Address - Street 1:725 S PINE ST
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-3654
Practice Address - Country:US
Practice Address - Phone:786-691-6462
Practice Address - Fax:727-954-6546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112118500Medicaid