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General NPI Number Information
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NPI Number | 1851322341
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Entity Type | Organization
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Legal Business Name | PANSEONAT MIRACLE LLC
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5400 BISCAYNE DR SUITE A
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City | NORTH PORT
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State | FL
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Zip | 34287-0000
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Country | US
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Telephone | 877-387-1777
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Fax |
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Provider Business Mailing Address
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Address Line | 5400 BISCAYNE DR SUITE A
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City | NORTH PORT
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State | FL
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Zip | 34287-0000
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Country | US
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Telephone | 877-387-1777
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DORIT YABROV
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Credential | M.D.
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Telephone | 941-484-9730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | ME 93717
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License Number State | FL
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