Healthcare Provider Details

I. General information

NPI: 1710695309
Provider Name (Legal Business Name): MADELIN MOYA BORROTO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

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 Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MADELIN MOYA BORROTO
Title or Position: DIRECTOR
Credential: MD
Phone: 786-309-0160