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General NPI Number Information
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NPI Number | 1295599355
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Entity Type | Organization
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Legal Business Name | DIGESTIVE 305 LLC
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Dates
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Enumeration Date | 02/09/2024
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Last Update Date | 02/09/2024
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Provider Practice Location Address
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Address Line | 940 HUNTING LODGE DRIVE
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City | MIAMI SPRINGS
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State | FL
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Zip | 33166
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Country | US
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Telephone | 305-505-7714
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Fax |
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Provider Business Mailing Address
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Address Line | 10 CANAL ST STE 277
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City | MIAMI SPRINGS
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State | FL
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Zip | 33166-4404
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Country | US
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Telephone | 305-505-7714
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | NGUYEN CABALLERO
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Credential | APRN
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Telephone | 305-505-7714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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