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General NPI Number Information
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NPI Number | 1952562472
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Entity Type | Individual
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Provider Name | MAIRI MUNOZ-BUSTAMANTE PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 550 BILTMORE WAY SUITE 120
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City | CORAL GABLES
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State | FL
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Zip | 33134-5730
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Country | US
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Telephone | 305-989-4384
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Fax |
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Provider Business Mailing Address
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Address Line | 370 SW 27TH RD
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City | MIAMI
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State | FL
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Zip | 33129-2237
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Country | US
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Telephone | 305-989-4384
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9104050
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License Number State | FL
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