Healthcare Provider Details

I. General information

NPI: 1841908431
Provider Name (Legal Business Name): MADELIN MOYA BORROTO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 SW 87TH AVE STE 306
MIAMI FL
33165-5474
US

IV. Provider business mailing address

15418 SW 31ST LN
MIAMI FL
33185-5900
US

V. Phone/Fax

Practice location:
  • Phone: 305-608-0656
  • Fax: 786-329-7430
Mailing address:
  • Phone: 786-309-0160
  • Fax: 786-329-7430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1215
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: