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General NPI Number Information
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NPI Number | 1679002109
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Entity Type | Organization
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Legal Business Name | C & V GABLES MEDICAL CENTER INC
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 470 BILTMORE WAY STE 200B
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City | CORAL GABLES
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State | FL
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Zip | 33134-5788
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Country | US
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Telephone | 305-445-5515
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Fax | 305-445-5518
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Provider Business Mailing Address
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Address Line | 470 BILTMORE WAY STE 200B
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City | CORAL GABLES
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State | FL
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Zip | 33134-5788
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Country | US
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Telephone | 305-445-5515
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Fax | 305-445-5518
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Authorized Official
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Title or Position | OWNER
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Name | CARLOS CANOVA DIAZ
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Credential | MD
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Telephone | 305-445-5515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME104666
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License Number State | FL
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