Healthcare Provider Details

I. General information

NPI: 1265906093
Provider Name (Legal Business Name): MED-SYNTHESIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7170 SW 117TH AVE
MIAMI FL
33183-2808
US

IV. Provider business mailing address

7170 SW 117TH AVE
MIAMI FL
33183-2808
US

V. Phone/Fax

Practice location:
  • Phone: 305-598-8788
  • Fax:
Mailing address:
  • Phone: 305-598-8788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH GAMBARDELLA
Title or Position: DOCTOR
Credential: D.C.
Phone: 305-598-8788