Healthcare Provider Details

I. General information

NPI: 1407436322
Provider Name (Legal Business Name): MARISOL TREJOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13818 SW 152ND ST PMB 278
MIAMI FL
33177
US

IV. Provider business mailing address

13818 SW 152ND ST PMB 278
MIAMI FL
33177
US

V. Phone/Fax

Practice location:
  • Phone: 252-412-8133
  • Fax:
Mailing address:
  • Phone: 252-412-8133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME173091
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: