Provider Demographics
NPI:1306220900
Name:VITERI MALONE, MARIUXI ALEXANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIUXI
Middle Name:ALEXANDRA
Last Name:VITERI MALONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIUXI
Other - Middle Name:ALEXANDRA
Other - Last Name:VITERI BARRIGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:901 TAMIAMI TRL S STE A2
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-3668
Practice Address - Country:US
Practice Address - Phone:941-484-3531
Practice Address - Fax:941-486-1701
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME155572207RH0000X, 207RX0202X
MA263978207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114076900Medicaid