Healthcare Provider Details

I. General information

NPI: 1538492731
Provider Name (Legal Business Name): LUCIANO PABLO MASTROGIOVANNI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2009
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 NW 14TH ST STE 713
MIAMI FL
33136-2118
US

IV. Provider business mailing address

1150 NW 14TH ST STE 713
MIAMI FL
33136-2118
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-1579
  • Fax:
Mailing address:
  • Phone: 305-243-1579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberME111326
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: