Healthcare Provider Details

I. General information

NPI: 1366069221
Provider Name (Legal Business Name): G & G MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 NW 29TH ST
MIAMI FL
33142-6618
US

IV. Provider business mailing address

8000 W FLAGLER ST STE 206
MIAMI FL
33144-2153
US

V. Phone/Fax

Practice location:
  • Phone: 786-703-9779
  • Fax: 786-703-9779
Mailing address:
  • Phone: 786-703-9779
  • Fax: 786-703-9784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAGELA HERRERA
Title or Position: OWNER
Credential:
Phone: 786-703-9779