Provider Demographics
NPI:1285681999
Name:POZUELO, MARIA DEFATIMA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DEFATIMA
Last Name:POZUELO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 SE TIFFANY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7564
Mailing Address - Country:US
Mailing Address - Phone:772-226-4978
Mailing Address - Fax:772-945-1815
Practice Address - Street 1:1651 SE TIFFANY AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7564
Practice Address - Country:US
Practice Address - Phone:772-223-4978
Practice Address - Fax:772-345-1815
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072078207RP1001X
FLME155490207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME155490OtherANTHEM BC/BS
OH352693OtherWELLCARE
OHR72078OtherAUMMA/APEX
OH2330561Medicaid
FLME155490Medicaid
OHP00224699OtherRAILROAD CARE
OH000000369587OtherANTHEM BC/BS
OH202394952027OtherCARESOURCE