Individual
MIR LAND EUGENE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, MS
Contact information
Practice address
4469 NW 167TH ST, OPA LOCKA, FL 33055-4311
(305) 621-1455
(305) 621-5508
Mailing address
11031 NE 6TH AVE, MIAMI, FL 33161-7182
(305) 398-6100
(305) 757-4465
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
764792100
—
FL
Enumeration date
06/16/2006
Last updated
03/25/2024
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