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General NPI Number Information
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NPI Number | 1871994194
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Entity Type | Organization
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Legal Business Name | DR SANDRA Y. MITJANS, INC
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Dates
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Enumeration Date | 09/05/2014
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Last Update Date | 09/05/2014
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Provider Practice Location Address
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Address Line | 700 E 25TH ST
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City | HIALEAH
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State | FL
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Zip | 33013-3817
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Country | US
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Telephone | 305-835-0700
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Fax | 305-696-0963
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Provider Business Mailing Address
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Address Line | 700 E 25TH ST
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City | HIALEAH
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State | FL
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Zip | 33013-3817
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Country | US
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Telephone | 305-835-0700
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Fax | 305-696-0963
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANDRA YVONNE MITJANS
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Credential | MD
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Telephone | 305-835-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME40785
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License Number State | FL
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