Provider Demographics
NPI:1952504797
Name:MIGUELEZ, MANUEL (PA)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:MIGUELEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:MANUEL
Other - Middle Name:
Other - Last Name:MIGUELEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:13055 SW 42ND ST STE 210
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3410
Mailing Address - Country:US
Mailing Address - Phone:305-485-8666
Mailing Address - Fax:305-485-0575
Practice Address - Street 1:13055 SW 42ND ST
Practice Address - Street 2:SUITE 210
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3406
Practice Address - Country:US
Practice Address - Phone:305-485-8666
Practice Address - Fax:305-485-8652
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100292363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical