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Organization
RENE N MAYORGA M D P A
Active
Organization
RENE N MAYORGA M D P A
Active
Other names
Country Walk Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RENE N MAYORGA M.D. (PRESIDENT)
(305) 378-1302
Entity
Organization
Contact information
Practice address
14261 SW 120TH ST, SUITE 110, MIAMI, FL 33186-7270
(305) 378-1302
(305) 378-1311
Mailing address
14261 SW 120TH ST, SUITE 110, MIAMI, FL 33186-7270
(305) 378-1302
(305) 378-1311
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME54068
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003349
NEIGHBORHOOD HEALTH PART
FL
01
—
0170072
UNITED
FL
05
—
061439400
—
FL
01
—
08688
BLUE CROSS BLUE SHIELD
FL
01
—
101635
AVMED
FL
01
—
14292
VISTA
FL
01
—
2132789
AETNA
FL
01
—
F00138402601
NEIGBORHOOD HEALTH
FL
Enumeration date
04/10/2006
Last updated
11/22/2011
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