Healthcare Provider Details

I. General information

NPI: 1063577476
Provider Name (Legal Business Name): NORTH GABLES FOOT CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 NW 7TH ST
MIAMI FL
33126-2307
US

IV. Provider business mailing address

4540 NW 7TH ST
MIAMI FL
33126-2307
US

V. Phone/Fax

Practice location:
  • Phone: 305-461-3448
  • Fax:
Mailing address:
  • Phone: 305-461-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2666
License Number StateFL

VIII. Authorized Official

Name: RICARDO REYES
Title or Position: MD
Credential:
Phone: 305-461-3448