Provider Demographics
NPI:1700916277
Name:TROFIMOVA, OLGA A (BA)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:A
Last Name:TROFIMOVA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9052 NW 145TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7335
Mailing Address - Country:US
Mailing Address - Phone:786-897-2752
Mailing Address - Fax:305-274-0841
Practice Address - Street 1:9380 SW 72ND ST STE B250
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5454
Practice Address - Country:US
Practice Address - Phone:305-274-3172
Practice Address - Fax:305-274-0841
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL759414300Medicaid