Healthcare Provider Details

I. General information

NPI: 1053766717
Provider Name (Legal Business Name): GUSTAVO DELGADO BRITO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GUSTAVO DELGADO BRITO ARNP

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E 25TH ST STE 312
HIALEAH FL
33013-3849
US

IV. Provider business mailing address

6980 NW 186TH ST # A520
HIALEAH FL
33015-3171
US

V. Phone/Fax

Practice location:
  • Phone: 305-392-0380
  • Fax: 305-603-9683
Mailing address:
  • Phone: 305-319-9105
  • Fax: 787-801-1784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9334048
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: