Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | ME57128 | FL |
NPI | 1194782557 |
---|---|
Provider Name | Dr. Onelia G Lage |
First Address | Miami, FL 33101-6960 |
Second Address | Miami, FL 33101-6960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 30/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3710271-00 | (05) | FL |
F44285 | (02) | FL |