Individual
MIRA M LOTFALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.B.B.CH
Contact information
Practice address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Mailing address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
28405
MN
207ZP0101X
Anatomic Pathology Physician
65883
MN
207ZP0101X
Anatomic Pathology Physician
D89548
MD
207ZP0101X
Anatomic Pathology Physician
Primary
ME156755
FL
Other
Enumeration date
04/11/2017
Last updated
05/29/2024
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