Healthcare Provider Details

I. General information

NPI: 1043001290
Provider Name (Legal Business Name): MS. MIA CHAYA OHANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 05/16/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20191 E COUNTRY CLUB DR APT 1602
AVENTURA FL
33180-3019
US

IV. Provider business mailing address

20191 E COUNTRY CLUB DR APT 1602
AVENTURA FL
33180-3019
US

V. Phone/Fax

Practice location:
  • Phone: 786-972-1199
  • Fax:
Mailing address:
  • Phone: 786-972-1199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: