Healthcare Provider Details

I. General information

NPI: 1033690292
Provider Name (Legal Business Name): MARIAESTER MAKACIO MORILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date: 04/05/2019
Reactivation Date: 04/10/2019

III. Provider practice location address

1193 W 49TH ST
HIALEAH FL
33012-3337
US

IV. Provider business mailing address

1193 W 49TH ST
HIALEAH FL
33012-3337
US

V. Phone/Fax

Practice location:
  • Phone: 305-777-9190
  • Fax:
Mailing address:
  • Phone: 305-777-9190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME168619
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: