Provider Demographics
NPI:1447213640
Name:EGUSQUIZA, MARIA VICTORIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:VICTORIA
Last Name:EGUSQUIZA
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 1:3220 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3606
Mailing Address - Country:US
Mailing Address - Phone:305-551-1195
Mailing Address - Fax:305-551-1094
Practice Address - Street 1:3220 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3606
Practice Address - Country:US
Practice Address - Phone:305-551-1195
Practice Address - Fax:305-551-1094
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 54356208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063401802Medicaid
FL063401800Medicaid
FLE22889Medicare UPIN