Provider Demographics
NPI:1033690292
Name:MAKACIO MORILLO, MARIAESTER
Entity type:Individual
Prefix:
First Name:MARIAESTER
Middle Name:
Last Name:MAKACIO MORILLO
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 1:1193 W 49TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3337
Mailing Address - Country:US
Mailing Address - Phone:305-777-9190
Mailing Address - Fax:
Practice Address - Street 1:1193 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3337
Practice Address - Country:US
Practice Address - Phone:305-777-9190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2025-01-30
Deactivation Date:2019-04-05
Deactivation Code:
Reactivation Date:2019-04-10
Provider Licenses
StateLicense IDTaxonomies
FLME168619208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123678200Medicaid