Individual
MRS. MARY ANGELS DISTASIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.P.A
Contact information
Practice address
150 E 1ST AVE STE 105, HIALEAH, FL 33010-4925
(305) 825-0300
(786) 209-2076
Mailing address
8895 FONTAINEBLEAU BLVD APT 105, MIAMI, FL 33172-4423
(305) 992-0171
(786) 209-2076
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/01/2016
Last updated
12/01/2016
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