Healthcare Provider Details

I. General information

NPI: 1144315482
Provider Name (Legal Business Name): OCTAVIO VASCONCELLO-COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8224 MILLS DR
MIAMI FL
33183-4805
US

IV. Provider business mailing address

8224 MILLS DR
MIAMI FL
33183-4805
US

V. Phone/Fax

Practice location:
  • Phone: 305-200-3992
  • Fax: 844-798-8917
Mailing address:
  • Phone: 305-200-3992
  • Fax: 844-798-8917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME87386
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: