Provider Demographics
NPI:1760270862
Name:PAEZ GALLARDO, MAYBER
Entity type:Individual
Prefix:
First Name:MAYBER
Middle Name:
Last Name:PAEZ GALLARDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8951 NW 148TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7323
Mailing Address - Country:US
Mailing Address - Phone:786-651-8116
Mailing Address - Fax:
Practice Address - Street 1:8951 NW 148TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33018-7323
Practice Address - Country:US
Practice Address - Phone:786-651-8116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLREQUEST363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily