Healthcare Provider Details

I. General information

NPI: 1447578091
Provider Name (Legal Business Name): MAYRET PADRON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3659 S MIAMI AVE SUITE#5004
MIAMI FL
33133-4227
US

IV. Provider business mailing address

3659 S MIAMI AVE SUITE#5004
MIAMI FL
33133-4227
US

V. Phone/Fax

Practice location:
  • Phone: 305-854-0616
  • Fax: 305-854-4384
Mailing address:
  • Phone: 305-854-0616
  • Fax: 305-854-4384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9105353
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: