Provider Demographics
NPI:1770505935
Name:ESTEVEZ, MIRIAM (MD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:ESTEVEZ
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 1:8000 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3522
Mailing Address - Country:US
Mailing Address - Phone:786-230-6127
Mailing Address - Fax:305-974-0150
Practice Address - Street 1:17395 N BAY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-3334
Practice Address - Country:US
Practice Address - Phone:305-974-0151
Practice Address - Fax:305-974-0150
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00791712080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260364100Medicaid
FLE5419XOtherMEDICARE ID
FLH35109Medicare UPIN