=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437574019
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GONZALO A CODINACH DCPA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2014
-----------------------------------------------------
Last Update Date | 02/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1345 SW 87TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33174-3308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-262-9818
-----------------------------------------------------
Fax | 305-262-8434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1345 SW 87TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33174-3308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-262-9818
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GONZALO A CODINACH
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 305-262-9818
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH5994
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------