Provider Demographics
NPI:1730188442
Name:BUGARIN-VIERA, MAGDALENA (MD)
Entity type:Individual
Prefix:DR
First Name:MAGDALENA
Middle Name:
Last Name:BUGARIN-VIERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MAGDALENA
Other - Middle Name:
Other - Last Name:BUGARIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 18946
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33679-8946
Mailing Address - Country:US
Mailing Address - Phone:813-870-6422
Mailing Address - Fax:813-870-3421
Practice Address - Street 1:4726 N HABANA AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7144
Practice Address - Country:US
Practice Address - Phone:813-870-6422
Practice Address - Fax:813-870-3421
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 67694207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32517Medicare ID - Type Unspecified
A49257Medicare UPIN