MEDICARE: MIRTA DAVID

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	374U00000X	Home Health Aide	CNA183606	FL

General Provider Information

NPI Number	:	1700231602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRTA DAVID

Provider Business Mailing Address
First Line	:	3115 LEE ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3712
Country	:	US
Telephone Number	:	305-785-2898
Fax Number	:	954-920-2694

Provider Business Practice Location Address
First Line	:	3115 LEE ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3712
Country	:	US
Telephone Number	:	305-785-2898
Fax Number	:	954-920-2694

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

Provider Enumeration Date	:	04/28/2016
Last Update Date	:	04/28/2016

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Directions to “ MIRTA DAVID ” Practice Location

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