Healthcare Provider Details

I. General information

NPI: 1679874655
Provider Name (Legal Business Name): SERMAN LUIS OJEDA GIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 NW 27TH AVE SUITE 130
MIAMI FL
33125-2157
US

IV. Provider business mailing address

1490 NW 27TH AVE SUITE 130
MIAMI FL
33125-2157
US

V. Phone/Fax

Practice location:
  • Phone: 305-635-7710
  • Fax: 305-637-8122
Mailing address:
  • Phone: 305-635-7710
  • Fax: 305-637-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME114961
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: