Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 120402006 | FL |
Y | 213ES0000X | Sports Medicine | 120402006 | FL |
NPI | 1205470838 |
---|---|
Provider Name | Paula M Haito Tribados |
First Address | Miami, FL 33192-4177 |
Second Address | Panama, PANAMA 00507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2019 |
Last Update Date | 06/11/2019 |