Healthcare Provider Details

I. General information

NPI: 1376584821
Provider Name (Legal Business Name): RUBEN GONZALEZ-VALLINA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9260 SW 72ND ST 217
MIAMI FL
33173-3275
US

IV. Provider business mailing address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-7330
  • Fax: 305-271-4219
Mailing address:
  • Phone: 305-271-7330
  • Fax: 305-271-4219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberME0055859
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: