Healthcare Provider Details

I. General information

NPI: 1174787576
Provider Name (Legal Business Name): MARIA GABRIELA TUPAYACHI ORTIZ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 NW 10TH AVE RM 7056
MIAMI FL
33136-1015
US

IV. Provider business mailing address

1600 NW 10TH AVE RM 7056
MIAMI FL
33136-1015
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6388
  • Fax: 305-243-6372
Mailing address:
  • Phone: 305-243-6388
  • Fax: 305-243-6372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number46755
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number46755
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: