Healthcare Provider Details

I. General information

NPI: 1104221597
Provider Name (Legal Business Name): ELIZABETH GAMEZ PARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 SW 67TH AVE
MIAMI FL
33144-4700
US

IV. Provider business mailing address

7925 NW 12TH ST STE 201
DORAL FL
33126-1821
US

V. Phone/Fax

Practice location:
  • Phone: 305-359-9838
  • Fax: 786-224-6490
Mailing address:
  • Phone: 305-874-3909
  • Fax: 305-874-3916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9358279
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: