Provider Demographics
NPI:1962775130
Name:TOVAR, MARIAM EMILIA (DOM)
Entity type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:EMILIA
Last Name:TOVAR
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5804 LAKE UNDEHILL RD. STE A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807
Mailing Address - Country:US
Mailing Address - Phone:954-867-6610
Mailing Address - Fax:407-203-6898
Practice Address - Street 1:11557 AMIDSHIP LN UNIT 7307
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-5535
Practice Address - Country:US
Practice Address - Phone:954-867-6610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3091171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist