Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | ME 0056044 | FL |
NPI | 1285789594 |
---|---|
Provider Name | Dr. Mary Ann Vaccarello |
First Address | Coral Gables, FL 33146-2423 |
Second Address | Mangonia Park, FL 33407-2450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 24/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
379171800 | (05) | FL |
ME 0056044 | MEDICAL LICENSE NUMBER (01) | FL |