MEDICARE: DARIEL GIL SR. MA

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	225700000X	Massage Therapist	67868	FL

General Provider Information

NPI Number	:	1538677893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARIEL GIL SR. MA

Provider Business Mailing Address
First Line	:	4915 NW 178TH TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-3234
Country	:	US
Telephone Number	:	786-515-7590
Fax Number	:	786-999-8234

Provider Business Practice Location Address
First Line	:	4915 NW 178TH TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-3234
Country	:	US
Telephone Number	:	786-515-7590
Fax Number	:	786-999-8234

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

Provider Enumeration Date	:	01/19/2018
Last Update Date	:	01/19/2018

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