Provider Demographics
NPI:1760618953
Name:TRIFILIO, MALVINA AMELIA
Entity Type:Individual
Prefix:MS
First Name:MALVINA
Middle Name:AMELIA
Last Name:TRIFILIO
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 1:855 NW 126TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2063
Mailing Address - Country:US
Mailing Address - Phone:786-261-5190
Mailing Address - Fax:305-225-4244
Practice Address - Street 1:855 NW 126TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33182-2063
Practice Address - Country:US
Practice Address - Phone:786-261-5190
Practice Address - Fax:305-225-4244
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS3133237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL610249200Medicaid