Provider Demographics
NPI:1013303551
Name:VERLA, MARIATU A (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MARIATU
Middle Name:A
Last Name:VERLA
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:MARIATU
Other - Middle Name:
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1330 BUDINGER AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4123
Mailing Address - Country:US
Mailing Address - Phone:407-498-3763
Mailing Address - Fax:407-498-3793
Practice Address - Street 1:1330 BUDINGER AVE STE 206
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4123
Practice Address - Country:US
Practice Address - Phone:407-498-3763
Practice Address - Fax:407-498-3793
Is Sole Proprietor?:No
Enumeration Date:2015-04-11
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR5949208D00000X
390200000X
FLME157946208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115207100Medicaid