Provider Demographics
NPI:1700656071
Name:ARENCIBIA PITA, LUIS
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:ARENCIBIA PITA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NW 87TH AVE APT C202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4531
Mailing Address - Country:US
Mailing Address - Phone:305-549-4324
Mailing Address - Fax:
Practice Address - Street 1:2300 N COMMERCE PKWY STE 103
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3255
Practice Address - Country:US
Practice Address - Phone:954-217-5700
Practice Address - Fax:954-217-5704
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11030379363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily