Provider Demographics
NPI:1275893158
Name:FRONTERAS, MIA ISADORA L (MD)
Entity Type:Individual
Prefix:
First Name:MIA ISADORA
Middle Name:L
Last Name:FRONTERAS
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 1:13901 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3905
Mailing Address - Country:US
Mailing Address - Phone:813-615-7620
Mailing Address - Fax:813-971-7953
Practice Address - Street 1:13901 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3905
Practice Address - Country:US
Practice Address - Phone:813-615-7620
Practice Address - Fax:813-971-7953
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127678207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism