Provider Demographics
NPI:1003924424
Name:FIALLO, MARTA MATEO
Entity Type:Individual
Prefix:MRS
First Name:MARTA
Middle Name:MATEO
Last Name:FIALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15051 ROYAL OAKS LN
Mailing Address - Street 2:#703
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2457
Mailing Address - Country:US
Mailing Address - Phone:954-882-5387
Mailing Address - Fax:786-888-2887
Practice Address - Street 1:2519 HUNTERS RUN WAY
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33327-1436
Practice Address - Country:US
Practice Address - Phone:954-882-5387
Practice Address - Fax:786-888-2887
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL279-0006593246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2648014400OtherBUREAU OF WORKERS COMPENS
NJ28184680000OtherLEGACY INDENTIFER
MAQ08426OtherBLUE CROSS BLUE SHEILD
PA2818468000OtherLEGACY INDENTIFER
MAQ08426OtherBLUE CROSS BLUE SHEILD