Individual
MIRIAM MERCEDES LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 W 68TH ST, HIALEAH, FL 33016-1804
(305) 362-3969
(305) 362-7909
Mailing address
2100 W 68TH ST, HIALEAH, FL 33016-1804
(305) 362-3969
(305) 362-7909
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
ME47182
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
035062100
—
FL
01
—
6189715
CIGNA
FL
Enumeration date
09/16/2006
Last updated
05/23/2008
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