Provider Demographics
NPI:1508257932
Name:FIALLO, NOEL (BS)
Entity Type:Individual
Prefix:MR
First Name:NOEL
Middle Name:
Last Name:FIALLO
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19130 NW 80TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5211
Mailing Address - Country:US
Mailing Address - Phone:786-302-3162
Mailing Address - Fax:
Practice Address - Street 1:14875 NW 77TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2568
Practice Address - Country:US
Practice Address - Phone:786-321-1400
Practice Address - Fax:786-687-0620
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0Medicaid