Provider Demographics
NPI:1417484387
Name:DELVASTO, ARIADNA MARIA (MD)
Entity type:Individual
Prefix:
First Name:ARIADNA
Middle Name:MARIA
Last Name:DELVASTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ARIADNA
Other - Middle Name:MARIA
Other - Last Name:DELVASTO-PERDOMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:20801 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2103
Mailing Address - Country:US
Mailing Address - Phone:305-653-1770
Mailing Address - Fax:
Practice Address - Street 1:20801 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-2103
Practice Address - Country:US
Practice Address - Phone:305-653-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME149318207Q00000X, 208D00000X
PR14165-I390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program