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General NPI Number Information
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NPI Number | 1003588625
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Entity Type | Individual
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Provider Name | MARIOLYS GOENAGA
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Gender | Female
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Dates
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Enumeration Date | 10/01/2021
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Last Update Date | 10/01/2021
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Provider Practice Location Address
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Address Line | 2711 SW 137TH AVE STE 94B
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City | MIAMI
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State | FL
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Zip | 33175-6361
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Country | US
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Telephone | 786-454-6038
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Fax |
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Provider Business Mailing Address
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Address Line | 2711 SW 137TH AVE STE 97
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City | MIAMI
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State | FL
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Zip | 33175-6361
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Country | US
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Telephone | 786-464-0207
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Fax | 786-953-4546
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | MA66020
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License Number State | FL
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