Healthcare Provider Details

I. General information

NPI: 1174516637
Provider Name (Legal Business Name): STUART GOTTLIEB MD CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 BILTMORE WAY SUITE 106
CORAL GABLES FL
33134-5755
US

IV. Provider business mailing address

475 BILTMORE WAY SUITE 106
CORAL GABLES FL
33134-5717
US

V. Phone/Fax

Practice location:
  • Phone: 305-461-1700
  • Fax: 305-461-1716
Mailing address:
  • Phone: 305-461-1700
  • Fax: 305-461-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: VICTOR GUILLERMO SOTO
Title or Position: PRESIDENT
Credential: MD
Phone: 305-461-1700