MEDICARE: MIGUEL A RIELO D.M.D

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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	DN22785	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376079939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGUEL A RIELO D.M.D

Provider Business Mailing Address
First Line	:	9556 SW 20TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-8019
Country	:	US
Telephone Number	:	786-375-1782
Fax Number	:

Provider Business Practice Location Address
First Line	:	9556 SW 20TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-8019
Country	:	US
Telephone Number	:	786-375-1782
Fax Number	:

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

Provider Enumeration Date	:	05/02/2017
Last Update Date	:	05/13/2020

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