Healthcare Provider Details

I. General information

NPI: 1689156911
Provider Name (Legal Business Name): GABRIEL D WORDLOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 W FLAGLER ST
MIAMI FL
33135-2209
US

IV. Provider business mailing address

3745 NE 171ST ST APT 60
MIAMI FL
33160-3085
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-7000
  • Fax:
Mailing address:
  • Phone: 305-219-8325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: