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General NPI Number Information
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NPI Number | 1720342470
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Entity Type | Individual
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Provider Name | GUSTAVO MARTIN HUAMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2012
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Last Update Date | 05/05/2021
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Provider Practice Location Address
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Address Line | 1475 W 49TH PL
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City | HIALEAH
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State | FL
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Zip | 33012-3113
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Country | US
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Telephone | 305-558-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 12565 NW 57TH CT
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City | CORAL SPRINGS
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State | FL
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Zip | 33076-3469
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Country | US
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Telephone | 954-393-8759
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9106514
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 32599
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License Number State | FL
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