Provider Demographics
NPI:1093105199
Name:OSORIO, GABRIEL D (PA)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:D
Last Name:OSORIO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 SW 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:COCONUT GROVE
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2764
Mailing Address - Country:US
Mailing Address - Phone:305-642-4263
Mailing Address - Fax:305-426-3329
Practice Address - Street 1:2750 SW 37TH AVE
Practice Address - Street 2:
Practice Address - City:COCONUT GROVE
Practice Address - State:FL
Practice Address - Zip Code:33133-2764
Practice Address - Country:US
Practice Address - Phone:305-642-4263
Practice Address - Fax:305-426-3329
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9108498OtherMEDICAL LICENSE