Provider Demographics
NPI:1225034861
Name:VIERA-NAVARRO, MARIANA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:VIERA-NAVARRO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIANA
Other - Middle Name:VIERA
Other - Last Name:NAVARRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5939 SW 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3136
Mailing Address - Country:US
Mailing Address - Phone:305-205-1314
Mailing Address - Fax:
Practice Address - Street 1:3915 BISCAYNE BLVD STE 406
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3737
Practice Address - Country:US
Practice Address - Phone:305-367-1176
Practice Address - Fax:877-391-0039
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102198363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9102198OtherPA STATE LICENSE
FLP96050Medicare UPIN