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General NPI Number Information
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NPI Number | 1053188417
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Entity Type | Organization
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Legal Business Name | ENDOONE DIABETES & ENDOCRINOLOGY CENTER, LLC
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Dates
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Enumeration Date | 12/06/2023
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 602 S AUDUBON AVE STE A
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City | TAMPA
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State | FL
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Zip | 33609-4217
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Country | US
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Telephone | 813-931-2424
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Fax | 813-869-3148
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Provider Business Mailing Address
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Address Line | 602 S AUDUBON AVE STE A
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City | TAMPA
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State | FL
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Zip | 33609-4217
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD
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Name | GUSTAVO ANTONIO MEYRELES CHALJUB
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Credential | MD
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Telephone | 813-931-2424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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