Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | ME47786 | FL |
NPI | 1174761126 |
---|---|
Provider Name | Mira Rosental |
First Address | North Miami Beach, FL 33162 |
Second Address | Miami, FL 33133-3609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2009 |
Last Update Date | 29/01/2009 |