Healthcare Provider Details

I. General information

NPI: 1447213640
Provider Name (Legal Business Name): MARIA VICTORIA EGUSQUIZA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 SW 107TH AVE
MIAMI FL
33165-3606
US

IV. Provider business mailing address

3220 SW 107TH AVE
MIAMI FL
33165-3606
US

V. Phone/Fax

Practice location:
  • Phone: 305-551-1195
  • Fax: 305-551-1094
Mailing address:
  • Phone: 305-551-1195
  • Fax: 305-551-1094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 54356
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: