MEDICARE: MAYRE URDANETA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME73691	FL

General Provider Information

NPI Number	:	1598744914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYRE URDANETA

Provider Business Mailing Address
First Line	:	7320 NW 114TH AVE
Second Line	:	APT 204
City	:	DORAL
State	:	FL
Zip	:	33178-5588
Country	:	US
Telephone Number	:	305-826-0606
Fax Number	:

Provider Business Practice Location Address
First Line	:	8060 NW 155TH ST STE 201
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5883
Country	:	US
Telephone Number	:	305-826-0606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	02/19/2013

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Directions to “ MAYRE URDANETA ” Practice Location

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