Provider Demographics
NPI:1679971881
Name:MAYORAL, MARIELI MILAGROS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIELI
Middle Name:MILAGROS
Last Name:MAYORAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIELI
Other - Middle Name:MILAGROS
Other - Last Name:MAYORAL-HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1732 S CONGRESS AVE STE 346
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2140
Mailing Address - Country:US
Mailing Address - Phone:561-353-1225
Mailing Address - Fax:
Practice Address - Street 1:7700 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-4818
Practice Address - Country:US
Practice Address - Phone:561-720-2942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18886208D00000X
FLACN1034208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN1034OtherSTATE OF FLORIDA
FLFM4992663OtherDEA