Healthcare Provider Details

I. General information

NPI: 1003012741
Provider Name (Legal Business Name): OSCAR LORET DE MOLA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7775 SW 87TH AVE SUITE 100
MIAMI FL
33173-2536
US

IV. Provider business mailing address

6800 BIRD RD SUITE 503
MIAMI FL
33155-3708
US

V. Phone/Fax

Practice location:
  • Phone: 305-274-8243
  • Fax: 305-274-8482
Mailing address:
  • Phone: 305-274-8243
  • Fax: 305-274-8482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: OSCAR LORET DE MOLA
Title or Position: OWNER
Credential: MD
Phone: 305-274-8243