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General NPI Number Information
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NPI Number | 1568835627
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Entity Type | Organization
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Legal Business Name | GAMALIEL G. MATTOS, MD
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Dates
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Enumeration Date | 11/10/2015
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Last Update Date | 11/10/2015
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Provider Practice Location Address
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Address Line | 4001 NW 97TH AVE SUITE 101
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City | DORAL
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State | FL
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Zip | 33178-2384
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Country | US
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Telephone | 305-418-2233
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Fax | 305-418-2295
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Provider Business Mailing Address
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Address Line | 4001 NW 97TH AVE SUITE 101
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City | DORAL
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State | FL
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Zip | 33178-2384
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Country | US
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Telephone | 305-418-2233
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Fax | 305-418-2295
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. GAMALIEL G MATTOS
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Credential | MD
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Telephone | 305-418-2233
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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 | ME92002
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License Number State | FL
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