Provider Demographics
NPI:1285965020
Name:HIALEAH MIRE OFFICE CORP
Entity type:Organization
Organization Name:HIALEAH MIRE OFFICE CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:CARBAYAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-442-7444
Mailing Address - Street 1:320 W 49TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3716
Mailing Address - Country:US
Mailing Address - Phone:305-685-7494
Mailing Address - Fax:305-819-3542
Practice Address - Street 1:320 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3716
Practice Address - Country:US
Practice Address - Phone:305-685-7494
Practice Address - Fax:305-819-3542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11650122300000X
FLDN16862122300000X
FLDN16786122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty