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General NPI Number Information
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NPI Number | 1174761126
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Entity Type | Individual
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Provider Name | MIRA ROSENTAL MD
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Gender | Female
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Dates
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Enumeration Date | 01/29/2009
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Last Update Date | 01/29/2009
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Provider Practice Location Address
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Address Line | 3250 S DIXIE HWY
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City | MIAMI
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State | FL
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Zip | 33133-3609
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Country | US
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Telephone | 305-441-0304
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Fax | 305-441-2947
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Provider Business Mailing Address
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Address Line | 909 NE 163 STR. SUITE 402
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162
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Country | US
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Telephone | 305-944-4111
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Fax | 305-944-1333
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | ME47786
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License Number State | FL
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