Provider Demographics
NPI:1760586457
Name:MINGUEZ, XIOMARA MARA (MD)
Entity Type:Individual
Prefix:DR
First Name:XIOMARA
Middle Name:MARA
Last Name:MINGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARA
Other - Middle Name:
Other - Last Name:MINGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:60 HAVEN AVE
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-2604
Mailing Address - Country:US
Mailing Address - Phone:212-927-2427
Mailing Address - Fax:212-927-2302
Practice Address - Street 1:60 HAVEN AVE
Practice Address - Street 2:SUITE B-2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2604
Practice Address - Country:US
Practice Address - Phone:212-927-2427
Practice Address - Fax:212-927-2302
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229914208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics