Healthcare Provider Details

I. General information

NPI: 1619338035
Provider Name (Legal Business Name): FLORIDA FAMILY CLINIC SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2016
Last Update Date: 03/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SW 27TH AVE STE 214
MIAMI FL
33145-2455
US

IV. Provider business mailing address

1800 SW 27TH AVE STE 214
MIAMI FL
33145-2455
US

V. Phone/Fax

Practice location:
  • Phone: 305-444-3580
  • Fax: 305-444-1736
Mailing address:
  • Phone: 305-444-3580
  • Fax: 305-444-1736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICARDO FRANCISCO GUTIERREZ
Title or Position: VICE PRESIDENT
Credential: MT, RN
Phone: 305-444-3580