MEDICARE: MGO PROFESSIONAL HEALTH CO

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	2084P0800X	Psychiatry Physician	ME87958	FL

General Provider Information

NPI Number	:	1801102835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MGO PROFESSIONAL HEALTH CO

Provider Business Mailing Address
First Line	:	8049 NW 155TH ST
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5874
Country	:	US
Telephone Number	:	305-822-2330
Fax Number	:	305-822-2339

Provider Business Practice Location Address
First Line	:	8049 NW 155TH ST
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5874
Country	:	US
Telephone Number	:	305-822-2330
Fax Number	:	305-822-2339

Authorized Official
Title or Position	:	MD
Name	:	MARIBEL AGUILERA
Credential	:
Telephone Number	:	305-822-2330

Provider Enumeration Date	:	08/27/2010
Last Update Date	:	06/23/2025

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Directions to “MGO PROFESSIONAL HEALTH CO ” Practice Location

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