Individual
DR. MARIANO R FIALLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3100 E FLETCHER AVE, TAMPA, FL 33613-4613
(813) 467-4242
(813) 467-4243
Mailing address
3100 E FLETCHER AVE, TAMPA, FL 33613-4613
(813) 467-4242
(813) 467-4243
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME61885
FL
2080A0000X
Pediatric Adolescent Medicine Physician
ME0061885
FL
2080P0203X
Pediatric Critical Care Medicine Physician
ME0061885
FL
208M00000X
Hospitalist Physician
ME0061885
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11314867
CAQH
FL
05
—
254343500
—
FL
01
—
43953
BLUE CROSS
FL
01
—
F09310
UPIN
FL
Enumeration date
11/29/2006
Last updated
02/10/2021
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