Healthcare Provider Details

I. General information

NPI: 1225027782
Provider Name (Legal Business Name): MARIO I QUIROS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16250 NW 57TH AVE
MIAMI LAKES FL
33014-6711
US

IV. Provider business mailing address

900 S PINE ISLAND RD SUITE 800
PLANTATION FL
33324-3920
US

V. Phone/Fax

Practice location:
  • Phone: 786-442-2136
  • Fax: 305-823-0914
Mailing address:
  • Phone: 305-821-8611
  • Fax: 305-827-1753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME59718
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: