=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225034861
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIANA VIERA-NAVARRO PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2005
-----------------------------------------------------
Last Update Date | 04/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3915 BISCAYNE BLVD STE 406
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33137-3737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-367-1176
-----------------------------------------------------
Fax | 877-391-0039
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5939 SW 27TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-3136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-205-1314
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA9102198
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------