Provider Demographics
NPI:1790306256
Name:MIA DONNA LLC
Entity Type:Organization
Organization Name:MIA DONNA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:LUCIA
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RNP
Authorized Official - Phone:786-223-5369
Mailing Address - Street 1:3122 SW 189TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5857
Mailing Address - Country:US
Mailing Address - Phone:786-223-5369
Mailing Address - Fax:954-272-9026
Practice Address - Street 1:7100 W 20TH AVE STE 304
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1812
Practice Address - Country:US
Practice Address - Phone:954-885-5030
Practice Address - Fax:954-272-9026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty