Basic Information
| Provider Information | |||||||||
| NPI: | 1467566711 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ CABAN | ||||||||
| FirstName: | ARELIS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 WEBB DR | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338373962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8635881424 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4543 PLEASANT HILL RD | ||||||||
| Address2: | STE A | ||||||||
| City: | POINCIANA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347593403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079337900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 11/23/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 16540 | PR | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | ACN679 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 16540 | 01 | PR | MEDICNE DOCTOR LICENSE | OTHER | ACN679 | 01 | FL | MEDICINE DOCTOR LIC | OTHER |