1629002571 NPI number — MARIAINES APOLO PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629002571 NPI number — MARIAINES APOLO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIAINES APOLO PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629002571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 VALENCIA AVE UNIT 142133
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAL GABLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33114-6987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-459-3970
Provider Business Mailing Address Fax Number:
305-459-3971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8339 NW 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33126-1841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-459-3970
Provider Business Practice Location Address Fax Number:
305-459-3971
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
APOLO
Authorized Official First Name:
MARIAINES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-322-8629

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  PO3228 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0131X , with the licence number: PO3228 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009493800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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