Healthcare Provider Details

I. General information

NPI: 1629384276
Provider Name (Legal Business Name): LINA LATORRE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINA MAICHEL MD

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 NW 97TH AVE STE 102
DORAL FL
33178-2911
US

IV. Provider business mailing address

4055 NW 97TH AVE STE 102
DORAL FL
33178-2911
US

V. Phone/Fax

Practice location:
  • Phone: 786-801-1945
  • Fax: 786-558-8190
Mailing address:
  • Phone: 786-801-1945
  • Fax: 786-558-8190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME159186
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME159186
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: