Healthcare Provider Details

I. General information

NPI: 1487787883
Provider Name (Legal Business Name): C MARZOUKA PROFESSIONAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15101 S.W 87 AVE
MIAMI FL
33157
US

IV. Provider business mailing address

6802 SW 144TH TER
VILLAGE OF PALMETTO BAY FL
33158-1728
US

V. Phone/Fax

Practice location:
  • Phone: 305-232-1209
  • Fax:
Mailing address:
  • Phone: 305-389-3262
  • Fax: 305-259-2979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberPO2792
License Number StateFL

VIII. Authorized Official

Name: DR. CYNTHIA MARZOUKA-LOSITO
Title or Position: OWNER
Credential: DPM
Phone: 305-389-3262