Provider Information for 1770106437
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STARLA SOUTHWARD
Sex: Female
NPI: 1770106437
Last Updated: 2022-04-28
Certification Date: 2022-04-28
Certification Date: 2022-04-28
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1770106437 | ||||||||||||||
| Enumeration Date | 2020-05-28 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 1951 NW 7TH AVE MIAMI, FL 33136-1104 United States Phone: | Fax: | ||||||||||||||
| Primary Practice Address | 1951 NW 7TH AVE FL 3 MIAMI, FL 33136-1104 United States Phone: 305-902-6347 | Fax: | ||||||||||||||
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