Healthcare Provider Details

I. General information

NPI: 1639892003
Provider Name (Legal Business Name): FABIOLA ALESSANDRA CAGNOLA FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 E 8TH AVE
HIALEAH FL
33010-4615
US

IV. Provider business mailing address

855 E 8TH AVE
HIALEAH FL
33010-4615
US

V. Phone/Fax

Practice location:
  • Phone: 305-855-5598
  • Fax:
Mailing address:
  • Phone: 305-888-5598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS64670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: