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General NPI Number Information
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NPI Number | 1083636013
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Entity Type | Organization
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Legal Business Name | T G C SERVICES INC
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 10/31/2011
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Provider Practice Location Address
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Address Line | 1150 NW 72ND AVE STE 650
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City | MIAMI
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State | FL
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Zip | 33126-1921
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Country | US
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Telephone | 305-403-2221
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Fax | 305-403-2262
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Provider Business Mailing Address
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Address Line | 1150 NW 72ND AVE STE 650
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City | MIAMI
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State | FL
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Zip | 33126-1921
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Country | US
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Telephone | 305-403-2221
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Fax | 305-403-2262
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. VIVIAN SALINAS
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Credential |
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Telephone | 305-403-2221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | HCC7131
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License Number State | FL
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