Healthcare Provider Details

I. General information

NPI: 1619167954
Provider Name (Legal Business Name): JOHN MURAGE GACHIANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 HICKORY ST STE B
MELBOURNE FL
32901-1973
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-3420
  • Fax: 321-434-3423
Mailing address:
  • Phone: 321-434-3420
  • Fax: 321-434-3423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number40396
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD.200930
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number40396
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME151776
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: