Healthcare Provider Details

I. General information

NPI: 1386005825
Provider Name (Legal Business Name): GALENO MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 NW 42ND AVE STE 204
MIAMI FL
33126-5670
US

IV. Provider business mailing address

351 NW 42ND AVE STE 204
MIAMI FL
33126-5670
US

V. Phone/Fax

Practice location:
  • Phone: 305-644-2212
  • Fax: 786-475-7787
Mailing address:
  • Phone: 305-644-2212
  • Fax: 786-475-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberACN584
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME66435
License Number StateFL

VIII. Authorized Official

Name: DR. EUGENIO ANGUEIRA
Title or Position: CEO
Credential: MD
Phone: 305-644-2212