Provider Demographics
NPI:1215138649
Name:ORTIGOSA-GOGGINS, MARIELLA (MD)
Entity type:Individual
Prefix:
First Name:MARIELLA
Middle Name:
Last Name:ORTIGOSA-GOGGINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 NW 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1101
Mailing Address - Country:US
Mailing Address - Phone:305-355-5000
Mailing Address - Fax:
Practice Address - Street 1:1801 NW 9TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1101
Practice Address - Country:US
Practice Address - Phone:305-355-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052624207RN0300X
FLME129384207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology