| Doctor Name: | JUAN D MIRABA; |
| NPI Number: | 1932308996 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | ME 67719 |
| Business Practice Address: | 1448 N Krome Ave Florida City, FL - 330342401 |
| Business Phone Number: | 3052450222 |
| Business Fax Number: | 3052456212 |
| Mailing Address: | 4483 Nw 36th St, Suite 120 MIAMI SPRINGS |
| State: | FL |
| Postal Code: | 331667260 |
| Phone Number: | 3058887555 |
| Fax Number: | 3058887410 |
| NPI Enumeration Date: | 07/11/2007 |
| NPI Last Update Date: | 07/11/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME 67719 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |