Healthcare Provider Details

I. General information

NPI: 1386723567
Provider Name (Legal Business Name): GUSTAVO PLASENCIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9195 SUNSET DR SUITE 230
MIAMI FL
33173-3452
US

IV. Provider business mailing address

9195 SUNSET DR SUITE 230
MIAMI FL
33173-3452
US

V. Phone/Fax

Practice location:
  • Phone: 786-466-6960
  • Fax: 305-279-1994
Mailing address:
  • Phone: 786-466-6960
  • Fax: 305-279-1994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME0031262
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME0031262
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: