| Doctor Name: | MIRNA ANTONIETA WAIDELE |
| NPI Number: | 1013938778 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | PA9101003 |
| Business Practice Address: | 7280 W Palmetto Park Rd Suite 104 Boca Raton, FL - 334333422 |
| Business Phone Number: | 5613916552 |
| Business Fax Number: | 5613916285 |
| Mailing Address: | 7280 W Palmetto Park Rd, Suite 104 BOCA RATON |
| State: | FL |
| Postal Code: | 334333422 |
| Phone Number: | 5613916552 |
| Fax Number: | 5613916285 |
| NPI Enumeration Date: | 07/21/2006 |
| NPI Last Update Date: | 06/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA9101003 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |