Provider Demographics
NPI:1265628564
Name:NEUROLOGY-NEUROSURGERY OF DADE AND AIDA VERGARA
Entity Type:Organization
Organization Name:NEUROLOGY-NEUROSURGERY OF DADE AND AIDA VERGARA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-514-9154
Mailing Address - Street 1:6760 NW 175TH LN APT 10H
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5856
Mailing Address - Country:US
Mailing Address - Phone:786-514-9154
Mailing Address - Fax:305-702-9441
Practice Address - Street 1:7150 W 20TH AVE STE 408
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5533
Practice Address - Country:US
Practice Address - Phone:786-514-9154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherFEDERAL TAX ID
U4776ZMedicare UPIN