Healthcare Provider Details

I. General information

NPI: 1821008376
Provider Name (Legal Business Name): VIRGILIO MAGDIEL ZALDIVAR LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SW 1ST ST 2ND FLOOR
MIAMI FL
33135-1601
US

IV. Provider business mailing address

1415 SW 99TH CT
MIAMI FL
33174-2823
US

V. Phone/Fax

Practice location:
  • Phone: 305-631-8933
  • Fax: 305-631-0546
Mailing address:
  • Phone: 305-216-6797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW6551
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: