Healthcare Provider Details

I. General information

NPI: 1134523871
Provider Name (Legal Business Name): MAGALIE SAMSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SW 216TH ST
MIAMI FL
33190
US

IV. Provider business mailing address

10300 SW 216TH ST
MIAMI FL
33190
US

V. Phone/Fax

Practice location:
  • Phone: 305-253-5100
  • Fax: 305-254-4987
Mailing address:
  • Phone: 305-253-5100
  • Fax: 305-254-4987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA9108055
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: