Provider Demographics
NPI:1497205827
Name:MLYM HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:MLYM HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FABELO
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:305-335-1127
Mailing Address - Street 1:19701 E LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2221
Mailing Address - Country:US
Mailing Address - Phone:305-335-1127
Mailing Address - Fax:
Practice Address - Street 1:19701 E LAKE DR
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2221
Practice Address - Country:US
Practice Address - Phone:305-335-1127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL681692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty