Fiallos, Mariano R
Fiallos, Mariano R is an individual health care provider with primary practice located at 3100 E Fletcher Ave , Tampa FL 33613-4613. He recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Adolescent Medicine, Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine, Allopathic & Osteopathic Physicians / Hospitalist, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is his primary health care specialty. Fiallos, Mariano R can be contacted via phone (813) 467-4242.Contact Information
Primary practice address
3100 E Fletcher Ave
Tampa FL 33613-4613
Phone: (813) 467-4242
Fax: (813) 467-4243
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Adolescent Medicine | 2080A0000X | ME0061885 | Florida |
| Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine | 2080P0203X | ME0061885 | Florida |
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | ME0061885 | Florida |
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | ME61885 | Florida |
Profile Details
| NPI number | 1154498772 |
|---|---|
| LBN Legal business name | Fiallos, Mariano R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 29th, 2006 |
| Last updated | Feb 10th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1154498772 | NPPES |
| Florida | Other | 11314867 | CAQH |
| Florida | MEDICAID | 254343500 | CAQH |
| Florida | Other | F09310 | CAQH |
| Florida | Other | 43953 | CAQH |
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