Healthcare Provider Details

I. General information

NPI: 1063353209
Provider Name (Legal Business Name): EVAGIANNY MICHELL CONTRERAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 W 20TH AVE
HIALEAH FL
33012-5874
US

IV. Provider business mailing address

102 BELLATRIX CT
GEORGETOWN KY
40324-9006
US

V. Phone/Fax

Practice location:
  • Phone: 305-825-0300
  • Fax:
Mailing address:
  • Phone: 502-591-7645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: