MEDICARE: DR CONSTATINO MEDIETA

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	208200000X	Plastic Surgery Physician	070055	FL

General Provider Information

NPI Number	:	1528547999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR CONSTATINO MEDIETA

Provider Business Mailing Address
First Line	:	2310 S DIXIE HWY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-2314
Country	:	US
Telephone Number	:	310-529-9237
Fax Number	:	626-331-3204

Provider Business Practice Location Address
First Line	:	2310 S DIXIE HWY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-2314
Country	:	US
Telephone Number	:	310-529-9237
Fax Number	:	626-331-3204

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CONSTATINO MEDIETA
Credential	:	MD
Telephone Number	:	310-529-9237

Provider Enumeration Date	:	08/07/2018
Last Update Date	:	08/07/2018

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Directions to “DR CONSTATINO MEDIETA ” Practice Location

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