Healthcare Provider Details

I. General information

NPI: 1396599577
Provider Name (Legal Business Name): EQUILIBRIUM MD CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11440 N KENDALL DR STE 110
MIAMI FL
33176-1024
US

IV. Provider business mailing address

13783 SW 66TH ST APT A219
MIAMI FL
33183-4516
US

V. Phone/Fax

Practice location:
  • Phone: 786-334-2494
  • Fax: 786-221-2883
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RUSDANY COLLADO FUENTES
Title or Position: OWNER
Credential: MD
Phone: 305-502-3553