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General NPI Number Information
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NPI Number | 1447545702
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Entity Type | Organization
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Legal Business Name | MAYRE URDANETA MD PA
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 06/15/2011
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Provider Practice Location Address
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Address Line | 8060 NORTH WEST 155 STREET SUITE 201
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City | MIAMI LAKES
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State | FL
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Zip | 33016
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Country | US
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Telephone | 305-826-0606
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Fax | 305-826-0630
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Provider Business Mailing Address
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Address Line | 8060 NORTH WEST 155 STREET SUITE 201
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City | MIAMI LAKES
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State | FL
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Zip | 33016
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Country | US
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Telephone | 305-826-0606
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Fax | 305-826-0630
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. MAYRE URDANETA
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Credential | MD
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Telephone | 305-826-0606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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