Provider Demographics
NPI:1649227927
Name:PRIETO, GENOVEVA C (MD)
Entity Type:Individual
Prefix:MS
First Name:GENOVEVA
Middle Name:C
Last Name:PRIETO
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 1:215 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4841
Mailing Address - Country:US
Mailing Address - Phone:305-441-7179
Mailing Address - Fax:305-448-7134
Practice Address - Street 1:215 GRAND AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33133-4841
Practice Address - Country:US
Practice Address - Phone:305-441-7174
Practice Address - Fax:305-448-7134
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME678262080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378074100Medicaid
FL27323OtherBCBS