Healthcare Provider Details

I. General information

NPI: 1871994194
Provider Name (Legal Business Name): DR SANDRA Y. MITJANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E 25TH ST
HIALEAH FL
33013-3817
US

IV. Provider business mailing address

700 E 25TH ST
HIALEAH FL
33013-3817
US

V. Phone/Fax

Practice location:
  • Phone: 305-835-0700
  • Fax: 305-696-0963
Mailing address:
  • Phone: 305-835-0700
  • Fax: 305-696-0963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME40785
License Number StateFL

VIII. Authorized Official

Name: SANDRA YVONNE MITJANS
Title or Position: PRESIDENT
Credential: MD
Phone: 305-835-0700