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General NPI Number Information
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NPI Number | 1265065528
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Entity Type | Organization
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Legal Business Name | MYL GROUP SERVICES CORP
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Dates
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Enumeration Date | 02/14/2020
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Last Update Date | 11/15/2021
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Provider Practice Location Address
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Address Line | 7480 FAIRWAY DR STE 208
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City | MIAMI LAKES
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State | FL
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Zip | 33014-6879
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Country | US
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Telephone | 669-235-4347
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 93RD ST APT 5H
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City | BAY HARBOR ISLANDS
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State | FL
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Zip | 33154-2347
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Country | US
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Telephone | 786-985-0685
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Fax |
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Authorized Official
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Title or Position | FAMILY ARNP
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Name | MRS. LUNA WAHNON BENAYOUN
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Credential | ARNP
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Telephone | 786-985-0685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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