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General NPI Number Information
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NPI Number | 1659334670
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Entity Type | Organization
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Legal Business Name | RENE N MAYORGA M D P A
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 14261 SW 120TH ST SUITE 110
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City | MIAMI
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State | FL
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Zip | 33186-7270
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Country | US
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Telephone | 305-378-1302
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Fax | 305-378-1311
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Provider Business Mailing Address
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Address Line | 14261 SW 120TH ST SUITE 110
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City | MIAMI
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State | FL
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Zip | 33186-7270
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Country | US
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Telephone | 305-378-1302
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Fax | 305-378-1311
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RENE N MAYORGA
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Credential | M.D.
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Telephone | 305-378-1302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME54068
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License Number State | FL
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