| Organization Name: | MGM IPA DADE 001 LLC |
| NPI Number: | 1619303112 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARIO ARMANDO ESPINO (CEO/PRESIDENT) |
| Mailing Address: | 8318 Sw 193rd St Cutler Bay |
| State: | FL US |
| Postal Code: | 331578085 |
| Phone Number: | 3059645119 |
| Fax Number: | |
| NPI Enumeration Date: | 09/17/2013 |
| NPI Last Update Date: | 09/17/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |