Healthcare Provider Details

I. General information

NPI: 1558467092
Provider Name (Legal Business Name): LUIS GUTIERREZ GALATAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 S DOUGLAS RD
CORAL GABLES FL
33134-6914
US

IV. Provider business mailing address

PO BOX 863481
ORLANDO FL
32886-3481
US

V. Phone/Fax

Practice location:
  • Phone: 305-445-8461
  • Fax: 904-346-0113
Mailing address:
  • Phone: 305-779-0885
  • Fax: 904-346-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0034957
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: