Healthcare Provider Details

I. General information

NPI: 1629002571
Provider Name (Legal Business Name): MARIAINES APOLO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8339 NW 12TH ST
DORAL FL
33126-1841
US

IV. Provider business mailing address

251 VALENCIA AVE UNIT 142133
CORAL GABLES FL
33114-6987
US

V. Phone/Fax

Practice location:
  • Phone: 305-459-3970
  • Fax: 305-459-3971
Mailing address:
  • Phone: 305-459-3970
  • Fax: 305-459-3971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO3228
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO3228
License Number StateFL

VIII. Authorized Official

Name: DR. MARIAINES APOLO
Title or Position: PRESIDENT
Credential: DPM
Phone: 305-322-8629