Healthcare Provider Details

I. General information

NPI: 1578985537
Provider Name (Legal Business Name): MAGALYS AMARILIS VITIELLO TOLEDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20801 NW 2ND AVE CHEN MEDICAL COUNTY LINE
MIAMI FL
33169-2103
US

IV. Provider business mailing address

20801 NW 2ND AVE CHEN MEDICAL COUNTY LINE
MIAMI FL
33169-2103
US

V. Phone/Fax

Practice location:
  • Phone: 305-653-1770
  • Fax: 305-650-0672
Mailing address:
  • Phone: 305-653-1770
  • Fax: 305-650-0672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME119561
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: