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General NPI Number Information
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NPI Number | 1487879417
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Entity Type | Individual
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Provider Name | LIGIA M RE PA
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 04/18/2023
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Provider Practice Location Address
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Address Line | 19000 SW 377TH ST
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City | FLORIDA CITY
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State | FL
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Zip | 33034-6407
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Country | US
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Telephone | 786-349-2369
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Fax |
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Provider Business Mailing Address
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Address Line | 14529 SW 171 TER
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City | MIAMI
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State | FL
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Zip | 33177
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Country | US
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Telephone | 305-254-3344
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Fax | 305-254-3344
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9100838
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License Number State | FL
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