Healthcare Provider Details

I. General information

NPI: 1972573319
Provider Name (Legal Business Name): MAYRA CAPOTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 01/09/2021
Certification Date: 01/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14400 NW 77TH CT STE 102
MIAMI LAKES FL
33016-1590
US

IV. Provider business mailing address

14400 NW 77TH CT STE 102
MIAMI LAKES FL
33016-1590
US

V. Phone/Fax

Practice location:
  • Phone: 305-823-7768
  • Fax: 305-823-2211
Mailing address:
  • Phone: 305-823-7768
  • Fax: 305-823-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME68714
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: