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General NPI Number Information
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NPI Number | 1457641227
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Entity Type | Organization
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Legal Business Name | MIRIAM MENDIVIL OD, PA
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Dates
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Enumeration Date | 04/14/2011
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 5434 SW 8TH ST
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City | CORAL GABLES
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State | FL
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Zip | 33134-2267
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Country | US
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Telephone | 305-444-8676
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Fax |
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Provider Business Mailing Address
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Address Line | 3180 SW 129TH AVE
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City | MIAMI
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State | FL
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Zip | 33175-2508
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Country | US
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Telephone | 305-905-9184
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Fax | 305-225-3986
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MIRIAM MENDIVIL
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Credential | OD
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Telephone | 305-905-9184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC4038
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License Number State | FL
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