MEDICARE: MARIA DEFATIMA POZUELO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	35072078	OH
2	207RP1001X	Pulmonary Disease Physician	ME155490	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME155490	OTHER	FL	ANTHEM BC/BS
2	352693	OTHER	OH	WELLCARE
3	R72078	OTHER	OH	AUMMA/APEX
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	P00224699	OTHER	OH	RAILROAD CARE
7	000000369587	OTHER	OH	ANTHEM BC/BS
8	202394952027	OTHER	OH	CARESOURCE

General Provider Information

NPI Number	:	1285681999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA DEFATIMA POZUELO MD

Provider Business Mailing Address
First Line	:	1651 SE TIFFANY AVE
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-7564
Country	:	US
Telephone Number	:	772-226-4978
Fax Number	:	772-945-1815

Provider Business Practice Location Address
First Line	:	1651 SE TIFFANY AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7564
Country	:	US
Telephone Number	:	772-223-4978
Fax Number	:	772-345-1815

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	05/01/2023

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