Healthcare Provider Details

I. General information

NPI: 1992948160
Provider Name (Legal Business Name): MAYRELY PUPO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 W FLAGLER ST
MIAMI FL
33135-1524
US

IV. Provider business mailing address

12171 SW 268TH ST
HOMESTEAD FL
33032-8001
US

V. Phone/Fax

Practice location:
  • Phone: 786-517-4888
  • Fax:
Mailing address:
  • Phone: 305-278-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9187248
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: