Provider Demographics
NPI:1568471639
Name:MIRIAM GARCIA PORTELA MD PA
Entity Type:Organization
Organization Name:MIRIAM GARCIA PORTELA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA PORTELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-541-9709
Mailing Address - Street 1:330 SW 27TH AVE
Mailing Address - Street 2:SUITE 509
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2961
Mailing Address - Country:US
Mailing Address - Phone:305-541-9709
Mailing Address - Fax:305-541-9304
Practice Address - Street 1:330 SW 27TH AVE
Practice Address - Street 2:SUITE 509
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2961
Practice Address - Country:US
Practice Address - Phone:305-541-9709
Practice Address - Fax:305-541-9304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-06
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0055651208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08984AMedicare ID - Type Unspecified
FLE58285Medicare UPIN