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NPI Code Detail

MEDICARE: MARIANA TOLOSA

MEDICARE: MARIANA TOLOSA
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
1363A00000XPhysician AssistantPA9113529FL

General Provider Information

NPI Number : 1780222109
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIANA TOLOSA
Provider Business Mailing Address
First Line : 1501 S MIAMI AVE
Second Line :
City : MIAMI
State : FL
Zip : 33129-1102
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1501 S MIAMI AVE
Second Line :
City : MIAMI
State : FL
Zip : 33129-1102
Country : US
Telephone Number : 305-376-7803
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2019
Last Update Date : 06/22/2023

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Directions to “ MARIANA TOLOSA ” Practice Location

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