Provider Demographics
NPI:1871994194
Name:DR SANDRA Y. MITJANS, INC
Entity type:Organization
Organization Name:DR SANDRA Y. MITJANS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:MITJANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-835-0700
Mailing Address - Street 1:700 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3817
Mailing Address - Country:US
Mailing Address - Phone:305-835-0700
Mailing Address - Fax:305-696-0963
Practice Address - Street 1:700 E 25TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3817
Practice Address - Country:US
Practice Address - Phone:305-835-0700
Practice Address - Fax:305-696-0963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40785208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056822800Medicaid