Organization
ROA-LICEA MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IRINA LICEA M.D (CO-OWNER)
(786) 564-2584
Entity
Organization
Contact information
Practice address
1321 NW 14TH STREET, SUITE 601, MIAMI, FL 33125-1659
(305) 545-4980
(305) 669-9820
Mailing address
1321 NW 14TH ST, SUITE 601, MIAMI, FL 33125-1673
(305) 545-4980
(305) 669-9820
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
10/27/2009
Last updated
07/19/2012
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