Healthcare Provider Details

I. General information

NPI: 1578040093
Provider Name (Legal Business Name): BRIAN JOSE VILLAFUERTE TRISOLINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14400 NW 77TH CT STE 306
MIAMI LAKES FL
33016-1592
US

IV. Provider business mailing address

8875 NW 23RD ST
DORAL FL
33172-2419
US

V. Phone/Fax

Practice location:
  • Phone: 305-653-5155
  • Fax: 305-653-5513
Mailing address:
  • Phone: 305-653-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME162188
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: