Healthcare Provider Details

I. General information

NPI: 1487129367
Provider Name (Legal Business Name): VICENTE JOSE COGOLLO MANGONES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 BIRD RD
MIAMI FL
33175-3530
US

IV. Provider business mailing address

12160 SW 1ST ST
MIAMI FL
33184-1623
US

V. Phone/Fax

Practice location:
  • Phone: 305-223-2000
  • Fax: 305-227-5556
Mailing address:
  • Phone: 305-491-6087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME163948
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: