Healthcare Provider Details

I. General information

NPI: 1417484387
Provider Name (Legal Business Name): ARIADNA MARIA DELVASTO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ARIADNA MARIA DELVASTO-PERDOMO MD

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20801 NW 2ND AVE
MIAMI GARDENS FL
33169-2103
US

IV. Provider business mailing address

20801 NW 2ND AVE
MIAMI GARDENS FL
33169-2103
US

V. Phone/Fax

Practice location:
  • Phone: 305-653-1770
  • Fax:
Mailing address:
  • Phone: 305-653-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME149318
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: