MEDICARE: ANDREA VICTORIA FARACI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	ME146881	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033572334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA VICTORIA FARACI M.D.

Provider Business Mailing Address
First Line	:	2300 W 84TH ST STE 500
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-5780
Country	:	US
Telephone Number	:	305-915-5495
Fax Number	:	305-824-9206

Provider Business Practice Location Address
First Line	:	2300 W 84TH ST STE 500
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-5780
Country	:	US
Telephone Number	:	305-512-4858
Fax Number	:	305-824-9206

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2016
Last Update Date	:	09/29/2020

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