MEDICARE: MR. EDUARDO GROS CHT

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
1	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	419395-9	OTHER	FL	MIAMI-DADE COUNTY-STATE OF FLORIDA (TAX COLLECTOR)

General Provider Information

NPI Number	:	1407087059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDUARDO GROS CHT

Provider Business Mailing Address
First Line	:	5121 SW 69TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-5737
Country	:	US
Telephone Number	:	305-662-6869
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 SW 69TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-5737
Country	:	US
Telephone Number	:	305-662-6869
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2009
Last Update Date	:	07/30/2009

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