Individual
MAIRIM DE LA RUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3100 SW 62ND AVE, MIAMI, FL 33155-3009
(305) 666-6511
Mailing address
3100 SW 62ND AVE, MIAMI, FL 33155-3009
(305) 666-6511
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME106724
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002322300
—
FL
Enumeration date
10/15/2007
Last updated
10/30/2019
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