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General NPI Number Information
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NPI Number | 1528258944
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Entity Type | Organization
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Legal Business Name | MANUEL GAINZA MEDICAL OFFICE INC
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 08/01/2007
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Provider Practice Location Address
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Address Line | 9786 SW 24TH ST
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City | MIAMI
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State | FL
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Zip | 33165-7574
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Country | US
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Telephone | 305-485-7833
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Fax |
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Provider Business Mailing Address
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Address Line | 9786 SW 24TH ST
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City | MIAMI
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State | FL
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Zip | 33165-7574
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Country | US
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Telephone | 305-485-7833
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MANUEL GAINZA
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Credential | MD
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Telephone | 954-599-9048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME86679
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License Number State | FL
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