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General NPI Number Information
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NPI Number | 1376883587
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Entity Type | Organization
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Legal Business Name | GOSPA MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 02/25/2013
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Last Update Date | 03/27/2013
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Provider Practice Location Address
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Address Line | 3452 W BOYNTON BEACH BLVD STE. 5
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-4633
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Country | US
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Telephone | 561-299-0910
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Fax |
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Provider Business Mailing Address
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Address Line | 3452 W BOYNTON BEACH BLVD STE. 5
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-4633
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Country | US
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Telephone | 561-299-0910
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Fax |
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Authorized Official
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Title or Position | MGRM
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Name | MRS. JACQUELINE FARBER
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Credential |
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Telephone | 561-299-0910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics 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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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