Healthcare Provider Details

I. General information

NPI: 1992896898
Provider Name (Legal Business Name): ANTONIO GANDIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANTONIO GANDIA MD

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 68TH ST
HIALEAH FL
33016-1801
US

IV. Provider business mailing address

PO BOX 534235
ATLANTA GA
30353-4235
US

V. Phone/Fax

Practice location:
  • Phone: 305-823-5000
  • Fax: 904-346-0113
Mailing address:
  • Phone: 305-651-2270
  • Fax: 904-346-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME0053887
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: