Provider Demographics
NPI:1225207483
Name:GULFSTREAM ANESTHESIA GROUP LLC
Entity Type:Organization
Organization Name:GULFSTREAM ANESTHESIA GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:R
Authorized Official - Last Name:MADERAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-822-4107
Mailing Address - Street 1:2140 W 68TH ST
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1815
Mailing Address - Country:US
Mailing Address - Phone:305-822-4107
Mailing Address - Fax:786-497-2989
Practice Address - Street 1:2140 W 68TH ST
Practice Address - Street 2:SUITE # 305
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1815
Practice Address - Country:US
Practice Address - Phone:305-822-4107
Practice Address - Fax:786-497-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty