MEDICARE: ANGEL GAMBOA TORRES

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	363LF0000X	Family Nurse Practitioner	F03200049	FL
2	363LF0000X	Family Nurse Practitioner	11006474	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841825775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL GAMBOA TORRES

Provider Business Mailing Address
First Line	:	6100 BLUE LAGOON DR STE 365
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-7010
Country	:	US
Telephone Number	:	786-322-7333
Fax Number	:	786-347-5022

Provider Business Practice Location Address
First Line	:	743 NE 167TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-2404
Country	:	US
Telephone Number	:	305-957-0017
Fax Number	:	786-629-3922

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

Provider Enumeration Date	:	03/11/2020
Last Update Date	:	02/01/2022

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