MEDICARE: MARIELLE DORVIL

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	164W00000X	Licensed Practical Nurse	5158395	FL

General Provider Information

NPI Number	:	1407339740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIELLE DORVIL

Provider Business Mailing Address
First Line	:	789 NW 118TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33168-2328
Country	:	US
Telephone Number	:	786-991-7829
Fax Number	:

Provider Business Practice Location Address
First Line	:	789 NW 118TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33168-2328
Country	:	US
Telephone Number	:	786-991-7829
Fax Number	:

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

Provider Enumeration Date	:	09/12/2018
Last Update Date	:	09/12/2018

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Directions to “ MARIELLE DORVIL ” Practice Location

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