MEDICARE: GRETEL TRULLENQUE D.O.

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	207Q00000X	Family Medicine Physician	OS8965	FL

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	:	1720076144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETEL TRULLENQUE D.O.

Provider Business Mailing Address
First Line	:	PO BOX 415033
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-5033
Country	:	US
Telephone Number	:	305-504-6136
Fax Number	:	305-448-6217

Provider Business Practice Location Address
First Line	:	1021 IVES DAIRY RD STE 214
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-2537
Country	:	US
Telephone Number	:	305-504-6136
Fax Number	:	305-448-6217

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	07/24/2023

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Directions to “ GRETEL TRULLENQUE D.O.” Practice Location

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