Healthcare Provider Details

I. General information

NPI: 1366405607
Provider Name (Legal Business Name): DR. MARIO A MIGLIETTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E ROBINSON ST UNIT 3301
ORLANDO FL
32801-4363
US

IV. Provider business mailing address

150 E ROBINSON ST UNIT 3301
ORLANDO FL
32801-4363
US

V. Phone/Fax

Practice location:
  • Phone: 202-802-5270
  • Fax: 706-230-8971
Mailing address:
  • Phone: 706-761-7367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MB06920900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2664
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number82324
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number11080
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: