Healthcare Provider Details

I. General information

NPI: 1124349501
Provider Name (Legal Business Name): ANTONELLA TOSTI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2010
Last Update Date: 06/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6704
  • Fax: 305-243-7538
Mailing address:
  • Phone: 305-243-6704
  • Fax: 305-243-7538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMFC1658
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: