Basic Information
Provider Information
NPI: 1215484704
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PALLARES
FirstName: MARGARITA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6200 SW 73RD ST
Address2:  
City: SOUTH MIAMI
State: FL
PostalCode: 331434679
CountryCode: US
TelephoneNumber: 7866624000
FaxNumber:  
Practice Location
Address1: 6200 SW 73RD ST
Address2:  
City: SOUTH MIAMI
State: FL
PostalCode: 331434679
CountryCode: US
TelephoneNumber: 7866624000
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/01/2016
LastUpdateDate: 09/01/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
364SA2100X9231374FLY Physician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care

No ID Information.


Home