MEDICARE: MIRIAM MERCEDES LARA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	ME47182	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6189715	OTHER	FL	CIGNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124124854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM MERCEDES LARA

Provider Business Mailing Address
First Line	:	2100 W 68TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-1804
Country	:	US
Telephone Number	:	305-362-3969
Fax Number	:	305-362-7909

Provider Business Practice Location Address
First Line	:	2100 W 68TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-1804
Country	:	US
Telephone Number	:	305-362-3969
Fax Number	:	305-362-7909

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	05/23/2008

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Directions to “ MIRIAM MERCEDES LARA ” Practice Location

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