Healthcare Provider Details

I. General information

NPI: 1851130892
Provider Name (Legal Business Name): MARIA KOLESOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ALTON RD
MIAMI BEACH FL
33139-8982
US

IV. Provider business mailing address

2899 COLLINS AVE APT 1034
MIAMI FL
33140-4416
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2273
  • Fax:
Mailing address:
  • Phone: 561-643-5430
  • 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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: