1114387966 NPI number — GASTRO HEALTH, PL

Table of content: (NPI 1114387966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114387966 NPI number — GASTRO HEALTH, PL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GASTRO HEALTH, PL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114387966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9500 S DADELAND BLVD
Provider Second Line Business Mailing Address:
STE 802
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33156-2824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-468-4185
Provider Business Mailing Address Fax Number:
305-675-3378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3661 S MIAMI AVE STE 907
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33133-4214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-856-7333
Provider Business Practice Location Address Fax Number:
305-675-3378
Provider Enumeration Date:
03/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
ALFREDO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRIMARY PHARMACY PHYSICIAN
Authorized Official Telephone Number:
305-856-7333

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  ME87519 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 008258300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com