Healthcare Provider Details

I. General information

NPI: 1366569055
Provider Name (Legal Business Name): LUIS R. GARCIA-MAYOL, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 PONCE DE LEON BLVD SUITE 605
CORAL GABLES FL
33134-2049
US

IV. Provider business mailing address

747 PONCE DE LEON BLVD SUITE 605
CORAL GABLES FL
33134-2049
US

V. Phone/Fax

Practice location:
  • Phone: 305-445-4535
  • Fax: 305-441-1879
Mailing address:
  • Phone: 305-445-4535
  • Fax: 305-441-1879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME0037831
License Number StateFL

VIII. Authorized Official

Name: LUIS R GARCIA MAYOL
Title or Position: OWNER
Credential: MD
Phone: 305-445-4535