Provider Demographics
NPI:1952562472
Name:MUNOZ-BUSTAMANTE, MAIRI (PA-C)
Entity Type:Individual
Prefix:
First Name:MAIRI
Middle Name:
Last Name:MUNOZ-BUSTAMANTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 SW 27TH RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-2237
Mailing Address - Country:US
Mailing Address - Phone:305-989-4384
Mailing Address - Fax:
Practice Address - Street 1:550 BILTMORE WAY
Practice Address - Street 2:SUITE 120
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5730
Practice Address - Country:US
Practice Address - Phone:305-989-4384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104050363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical