Basic Information
| Provider Information | |||||||||
| NPI: | 1790306256 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIA DONNA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3122 SW 189TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330295857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862235369 | ||||||||
| FaxNumber: | 9542729026 | ||||||||
| Practice Location | |||||||||
| Address1: | 7100 W 20TH AVE STE 304 | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330161812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548855030 | ||||||||
| FaxNumber: | 9542729026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2020 | ||||||||
| LastUpdateDate: | 05/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | MARTINEZ | ||||||||
| AuthorizedOfficialFirstName: | OLGA | ||||||||
| AuthorizedOfficialMiddleName: | LUCIA | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7862235369 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RNP | ||||||||
| NPICertificationDate: | 05/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.