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NPI Code Detail

MEDICARE: GABRIEL OMAR ESTRADA SOTOMAYOR MD

MEDICARE: GABRIEL OMAR ESTRADA SOTOMAYOR MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician25643NV

General Provider Information

NPI Number : 1235711326
Entity Type Code : Individual
Provider Name (Legal Business Name) : GABRIEL OMAR ESTRADA SOTOMAYOR MD
Provider Business Mailing Address
First Line : 6101 BLUE LAGOON DR STE 200
Second Line :
City : MIAMI
State : FL
Zip : 33126-3168
Country : US
Telephone Number : 702-832-4562
Fax Number : 888-481-1462
Provider Business Practice Location Address
First Line : 2335 E LAKE MEAD BLVD
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-7141
Country : US
Telephone Number : 702-729-6739
Fax Number : 888-481-1462
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2021
Last Update Date : 02/26/2025

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