Healthcare Provider Details

I. General information

NPI: 1598744914
Provider Name (Legal Business Name): MAYRE URDANETA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8060 NW 155TH ST STE 201
MIAMI LAKES FL
33016-5883
US

IV. Provider business mailing address

7320 NW 114TH AVE APT 204
DORAL FL
33178-5588
US

V. Phone/Fax

Practice location:
  • Phone: 305-826-0606
  • Fax:
Mailing address:
  • Phone: 305-826-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME73691
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: