Provider Demographics
NPI:1699976357
Name:MAFUT, DAMARIS (DO)
Entity type:Individual
Prefix:
First Name:DAMARIS
Middle Name:
Last Name:MAFUT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9020 SW 137TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1430
Mailing Address - Country:US
Mailing Address - Phone:305-777-3505
Mailing Address - Fax:
Practice Address - Street 1:9020 SW 137TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1430
Practice Address - Country:US
Practice Address - Phone:305-777-3505
Practice Address - Fax:786-866-2599
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6468208000000X
FLOS10933208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics