| Doctor Name: | MIRIAM MERCEDES LARA |
| NPI Number: | 1124124854 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | ME47182 |
| Business Practice Address: | 2100 W 68th St Hialeah, FL - 330161804 |
| Business Phone Number: | 3053623969 |
| Business Fax Number: | 3053627909 |
| Mailing Address: | 2100 W 68th St, HIALEAH |
| State: | FL |
| Postal Code: | 330161804 |
| Phone Number: | 3053623969 |
| Fax Number: | 3053627909 |
| NPI Enumeration Date: | 09/16/2006 |
| NPI Last Update Date: | 05/23/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME47182 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |