Healthcare Provider Details

I. General information

NPI: 1619170123
Provider Name (Legal Business Name): FEDERICO GOROSTIAGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FEDERICO GOROSTIAGA RODRIGUEZ MD

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2118
US

IV. Provider business mailing address

8900 N KENDALL DR
MIAMI FL
33176-2118
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-6944
  • Fax:
Mailing address:
  • Phone: 786-596-6944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME116039
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number230858
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number045849
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: