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General NPI Number Information
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NPI Number | 1841712866
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Entity Type | Individual
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Provider Name | BERENICE SUBERO PABLO MD
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Gender | Female
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 1190 NE 125TH ST
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City | NORTH MIAMI
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State | FL
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Zip | 33161-5020
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Country | US
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Telephone | 305-891-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 1395 NW 167TH ST
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-5710
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Country | US
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Telephone | 305-628-6117
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME142432
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License Number State | FL
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