Healthcare Provider Details

I. General information

NPI: 1508800244
Provider Name (Legal Business Name): THRESIA B GAMBON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 WEST 51ST PLACE CITRUS HEALTH NETWORK INC
HIALEAH FL
33012-3300
US

IV. Provider business mailing address

551 WEST 51ST PLACE CITRUS HEALTH NETWORK INC
HIALEAH FL
33012-3300
US

V. Phone/Fax

Practice location:
  • Phone: 305-817-6560
  • Fax: 786-209-2030
Mailing address:
  • Phone: 305-817-6560
  • Fax: 786-209-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0072798
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: