Healthcare Provider Details

I. General information

NPI: 1508122110
Provider Name (Legal Business Name): MIRLA L AVILA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3683 S MIAMI AVE STE 420
MIAMI FL
33133-4240
US

IV. Provider business mailing address

9960 NW 116TH WAY STE 13
MEDLEY FL
33178-1175
US

V. Phone/Fax

Practice location:
  • Phone: 786-655-8010
  • Fax: 786-655-8013
Mailing address:
  • Phone: 786-924-1311
  • Fax: 786-924-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME178240
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberQ9782
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberQ9782
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: