Provider Demographics
NPI:1114067691
Name:URBINA, MARIELA A (MD)
Entity Type:Individual
Prefix:MISS
First Name:MARIELA
Middle Name:A
Last Name:URBINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2876 SW 144TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7445
Mailing Address - Country:US
Mailing Address - Phone:305-228-3714
Mailing Address - Fax:305-228-6153
Practice Address - Street 1:2760 SW 97TH AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2684
Practice Address - Country:US
Practice Address - Phone:305-228-3714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75494208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254678700Medicaid