Healthcare Provider Details

I. General information

NPI: 1043293368
Provider Name (Legal Business Name): CORAL GABLES ANESTHESIA ASSOCIATION CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 SW 63RD AVE
MIAMI FL
33155-3062
US

IV. Provider business mailing address

PO BOX 816759
HOLLYWOOD FL
33081-0759
US

V. Phone/Fax

Practice location:
  • Phone: 305-661-5597
  • Fax: 305-661-3549
Mailing address:
  • Phone: 305-674-1233
  • Fax: 954-964-6084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAISY MACIAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 954-964-2450