Provider Demographics
NPI:1184017238
Name:GULFSHORE PERSONALIZED CARE LLC
Entity Type:Organization
Organization Name:GULFSHORE PERSONALIZED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-366-2194
Mailing Address - Street 1:1250 S TAMIAMI TRL
Mailing Address - Street 2:STE 401
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2221
Mailing Address - Country:US
Mailing Address - Phone:941-366-2194
Mailing Address - Fax:877-620-5910
Practice Address - Street 1:1250 S TAMIAMI TRL
Practice Address - Street 2:STE 401
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2221
Practice Address - Country:US
Practice Address - Phone:941-366-2194
Practice Address - Fax:941-366-7025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7384207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS7384OtherMEDICAL LICENSE