Healthcare Provider Details

I. General information

NPI: 1588601686
Provider Name (Legal Business Name): RAMIRO M GUMUCIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 INDIAN CREEK DR APT 1301
MIAMI BEACH FL
33140-4064
US

IV. Provider business mailing address

3411 INDIAN CREEK DR APT 1301
MIAMI BEACH FL
33140-4064
US

V. Phone/Fax

Practice location:
  • Phone: 305-205-3653
  • Fax:
Mailing address:
  • Phone: 305-205-3653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME95648
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: