Healthcare Provider Details

I. General information

NPI: 1538491063
Provider Name (Legal Business Name): GASTROMED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 01/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 SW 8TH STREET SUITE 200
CORAL GABLES FL
33134-2442
US

IV. Provider business mailing address

5101 SW 8TH STREET SUITE 200
CORAL GABLES FL
33134-2442
US

V. Phone/Fax

Practice location:
  • Phone: 305-262-6060
  • Fax: 305-262-6038
Mailing address:
  • Phone: 305-359-5037
  • Fax: 786-509-5544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: GLADYS LLANO
Title or Position: COO
Credential:
Phone: 305-262-6060