| Mariscal Pediatrics and Family Medicine | |
|
12991 Sw 112th St Miami FL 33186-4769 | |
| (786) 298-3854 | |
| Not Available |
| Full Name | Mariscal Pediatrics and Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 12991 Sw 112th St, Miami, Florida |
| Authorized Official Name and Position | Liuska Mariscal (OWNER) |
| Authorized Official Contact | 7867038174 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mariscal Pediatrics and Family Medicine 12991 Sw 112th St Miami FL 33186-4769 Ph: (786) 703-8174 | Mariscal Pediatrics and Family Medicine 12991 Sw 112th St Miami FL 33186-4769 Ph: (786) 298-3854 |
| NPI Number | 1073924981 |
|---|---|
| Provider Enumeration Date | 05/13/2014 |
| Last Update Date | 01/14/2023 |
| Certification Date | 12/14/2022 |
| Medicare PECOS PAC ID | 7618218736 |
|---|---|
| Medicare Enrollment ID | O20190417002167 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073924981 | NPI | - | NPPES |
| 127271635 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 208000000X | Pediatrics | ME 95687 (Florida) | Secondary |
| Provider Name | Liuska MD Mariscal |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1083769384 PECOS PAC ID: 9032450150 Enrollment ID: I20190417002785 |
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