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General NPI Number Information
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NPI Number | 1619588324
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Entity Type | Organization
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Legal Business Name | MIAMI LAKES DOCTOR'S LLC
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Dates
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Enumeration Date | 08/14/2020
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Last Update Date | 07/20/2021
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Provider Practice Location Address
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Address Line | 5779 NW 151ST ST
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2483
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Country | US
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Telephone | 786-353-2058
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Fax | 786-353-2087
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Provider Business Mailing Address
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Address Line | 5757 NW 151ST ST
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2482
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Country | US
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Telephone | 786-353-2058
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Fax | 786-353-2087
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. YANET TEJEDA GARCIA
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Credential | MEDICAL ASSISTANT
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Telephone | 786-797-7140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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