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NPI Code Detail

MEDICARE: MYRLANDE ETIENNE BA

MEDICARE: MYRLANDE ETIENNE BA
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1558453613
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYRLANDE ETIENNE BA
Provider Business Mailing Address
First Line : 11031 NE 6TH AVE
Second Line :
City : MIAMI
State : FL
Zip : 33161-7182
Country : US
Telephone Number : 305-398-6100
Fax Number : 305-757-4465
Provider Business Practice Location Address
First Line : 450 E ATLANTIC BLVD
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33060-6256
Country : US
Telephone Number : 954-781-4405
Fax Number : 954-785-6120
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 07/08/2007

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Directions to “ MYRLANDE ETIENNE BA” Practice Location

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