Provider Demographics
NPI:1235670464
Name:DAVARO, FACUNDO
Entity type:Individual
Prefix:
First Name:FACUNDO
Middle Name:
Last Name:DAVARO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:FACUNDO
Other - Middle Name:
Other - Last Name:DAVARO-COMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7183 ROCKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3615
Mailing Address - Country:US
Mailing Address - Phone:774-258-1432
Mailing Address - Fax:
Practice Address - Street 1:200 SE HOSPITAL AVE # 2346
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2346
Practice Address - Country:US
Practice Address - Phone:772-287-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME159110208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program