Healthcare Provider Details

I. General information

NPI: 1700851458
Provider Name (Legal Business Name): MIRIAM MERCEDES MALDONADO LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10540 NW 26TH STREET BLDG G UNIT 108
DORAL FL
33172-2104
US

IV. Provider business mailing address

PO BOX 557203
MIAMI FL
33255-7203
US

V. Phone/Fax

Practice location:
  • Phone: 786-607-2229
  • Fax: 813-365-3074
Mailing address:
  • Phone: 786-234-9056
  • Fax: 813-365-3074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW165
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: