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General NPI Number Information
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NPI Number | 1790306256
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Entity Type | Organization
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Legal Business Name | MIA DONNA LLC
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Dates
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Enumeration Date | 05/06/2020
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Last Update Date | 05/06/2020
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Provider Practice Location Address
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Address Line | 7100 W 20TH AVE STE 304
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City | HIALEAH
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State | FL
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Zip | 33016-1812
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Country | US
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Telephone | 954-885-5030
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Fax | 954-272-9026
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Provider Business Mailing Address
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Address Line | 3122 SW 189TH AVE
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City | MIRAMAR
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State | FL
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Zip | 33029-5857
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Country | US
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Telephone | 786-223-5369
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Fax | 954-272-9026
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. OLGA LUCIA MARTINEZ
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Credential | RNP
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Telephone | 786-223-5369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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