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General NPI Number Information
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NPI Number | 1447898218
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Entity Type | Individual
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Provider Name | GUSTAVO H SHIMABUCO LPN
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Gender | Male
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Dates
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Enumeration Date | 12/12/2019
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Last Update Date | 12/12/2019
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Provider Practice Location Address
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Address Line | 9734 W SAMPLE RD
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4004
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Country | US
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Telephone | 954-903-1323
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Fax | 786-664-3342
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Provider Business Mailing Address
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Address Line | 9734 W SAMPLE RD
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4004
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Country | US
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Telephone | 954-903-1323
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Fax | 786-664-3342
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN5203997
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License Number State | FL
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