Healthcare Provider Details

I. General information

NPI: 1295159630
Provider Name (Legal Business Name): KENIA CARBONELL MURIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490NW27TH AVE 130
MIAMI FL
33125-2173
US

IV. Provider business mailing address

6100 BLUE LAGOON DR 365
MIAMI FL
33126-7010
US

V. Phone/Fax

Practice location:
  • Phone: 305-635-7710
  • Fax: 786-621-7817
Mailing address:
  • Phone: 786-322-7358
  • Fax: 786-322-7329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9339297
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: