Provider Demographics
NPI:1285867440
Name:LUIS C GONZALEZ SERVA MD PA
Entity Type:Organization
Organization Name:LUIS C GONZALEZ SERVA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:GONZALEZ SERVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-621-3897
Mailing Address - Street 1:3181 SW 22 STREET
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145
Mailing Address - Country:US
Mailing Address - Phone:786-621-3897
Mailing Address - Fax:786-975-2643
Practice Address - Street 1:3181 SW 22 STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145
Practice Address - Country:US
Practice Address - Phone:786-621-3897
Practice Address - Fax:786-975-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty