Healthcare Provider Details

I. General information

NPI: 1841635992
Provider Name (Legal Business Name): ENRIQUE GORIN, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21110 BISCAYNE BLVD. SUITE #206
AVENTURA FL
33180
US

IV. Provider business mailing address

21110 BISCAYNE BLVD. SUITE #206
AVENTURA FL
33180
US

V. Phone/Fax

Practice location:
  • Phone: 305-933-2111
  • Fax: 305-933-3203
Mailing address:
  • Phone: 305-933-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberME29240
License Number StateFL

VIII. Authorized Official

Name: ENRIQUE GORIN
Title or Position: PHYSICIAN
Credential: MD
Phone: 305-933-2111