Healthcare Provider Details

I. General information

NPI: 1356389266
Provider Name (Legal Business Name): G & C MEDICAL CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 NW 36TH ST SUITE 328
VIRGINIA GARDENS FL
33166-6978
US

IV. Provider business mailing address

6555 NW 36TH ST SUITE 328
VIRGINIA GARDENS FL
33166-6978
US

V. Phone/Fax

Practice location:
  • Phone: 786-506-6323
  • Fax: 305-805-8566
Mailing address:
  • Phone: 786-506-6323
  • Fax: 305-805-8566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number603290-8
License Number StateFL

VIII. Authorized Official

Name: MR. GILBERTO J CASTILLO
Title or Position: PRESIDENT
Credential:
Phone: 786-506-6323