Provider Demographics
NPI:1659814747
Name:IANNINI, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:IANNINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ALHAMBRA CIR APT 302
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4699
Mailing Address - Country:US
Mailing Address - Phone:786-527-1721
Mailing Address - Fax:
Practice Address - Street 1:12940 SW 128TH ST STE 104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-8713
Practice Address - Country:US
Practice Address - Phone:305-562-4683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program