Provider Demographics
NPI:1043293368
Name:CORAL GABLES ANESTHESIA ASSOCIATION CORP
Entity Type:Organization
Organization Name:CORAL GABLES ANESTHESIA ASSOCIATION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-964-2450
Mailing Address - Street 1:PO BOX 816759
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33081-0759
Mailing Address - Country:US
Mailing Address - Phone:305-674-1233
Mailing Address - Fax:954-964-6084
Practice Address - Street 1:2410 SW 63RD AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3062
Practice Address - Country:US
Practice Address - Phone:305-661-5597
Practice Address - Fax:305-661-3549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45843Medicare ID - Type Unspecified