Healthcare Provider Details

I. General information

NPI: 1982687299
Provider Name (Legal Business Name): MARIA C GAVIRIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 02/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 S MIAMI AVE
MIAMI FL
33133-4253
US

IV. Provider business mailing address

PO BOX 64485
BALTIMORE MD
21264-4485
US

V. Phone/Fax

Practice location:
  • Phone: 305-854-0616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME130240
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: