Healthcare Provider Details

I. General information

NPI: 1215074331
Provider Name (Legal Business Name): JAPHET GAZTAMBIDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 12TH ST UNIT 102
SAINT CLOUD FL
34769-3723
US

IV. Provider business mailing address

1221 12TH ST UNIT 102
SAINT CLOUD FL
34769-3723
US

V. Phone/Fax

Practice location:
  • Phone: 407-556-3720
  • Fax: 407-556-3719
Mailing address:
  • Phone: 407-556-3720
  • Fax: 407-556-3719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberACN992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: