MEDICARE: MRS. MARTHA GAVIRIA

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	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528443090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTHA GAVIRIA

Provider Business Mailing Address
First Line	:	15694 NE 12TH AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-5504
Country	:	US
Telephone Number	:	786-344-0490
Fax Number	:

Provider Business Practice Location Address
First Line	:	15694 NE 12TH AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-5504
Country	:	US
Telephone Number	:	786-344-0490
Fax Number	:

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

Provider Enumeration Date	:	07/27/2015
Last Update Date	:	07/27/2015

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