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General NPI Number Information
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NPI Number | 1225295892
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Entity Type | Organization
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Legal Business Name | ARIEL GASTROENTEROLOGY, P.A.
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 7100 W 20TH AVE SUITE 412
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City | HIALEAH
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State | FL
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Zip | 33016-1897
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Country | US
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Telephone | 305-820-0006
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Fax | 305-828-6700
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Provider Business Mailing Address
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Address Line | 12400 SW 1ST CT
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City | PLANTATION
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State | FL
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Zip | 33325-2702
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Country | US
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Telephone | 954-483-8335
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Fax | 305-828-6700
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Authorized Official
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Title or Position | REGISTERED AGENT/GASTROENTEROLOGIST
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Name | DR. WILSON NICOLAS OTERO
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Credential | M.D.
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Telephone | 954-483-8422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME0044788
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License Number State | FL
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