Healthcare Provider Details

I. General information

NPI: 1639397557
Provider Name (Legal Business Name): LIVIA CORAL GADEA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LIVIA CORAL GADEA MD

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 COLLINS AVE APT .1203
MIAMI BEACH FL
33140-2300
US

IV. Provider business mailing address

5757 COLLINS AVE APT .1203
MIAMI BEACH FL
33140-2300
US

V. Phone/Fax

Practice location:
  • Phone: 305-903-7646
  • Fax:
Mailing address:
  • Phone: 305-903-7646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME104648
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME104648
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME104648
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: