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General NPI Number Information
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NPI Number | 1295164481
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Entity Type | Organization
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Legal Business Name | THE G GENERAL SERV, INC
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 11/13/2013
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Provider Practice Location Address
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Address Line | 2140 W FLAGLER ST STE 209
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City | MIAMI
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State | FL
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Zip | 33135-1642
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Country | US
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Telephone | 305-541-8770
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Fax |
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Provider Business Mailing Address
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Address Line | 2140 W FLAGLER ST STE 209
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City | MIAMI
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State | FL
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Zip | 33135-1642
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Country | US
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Telephone | 305-541-8770
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. MANUEL FERNANDEZ GONZALEZ
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Credential | M.D.
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Telephone | 786-261-6935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | ME17907
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License Number State | FL
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