Provider Demographics
NPI:1346304730
Name:CODINACH, GONZALO ANTONIO (DC)
Entity Type:Individual
Prefix:DR
First Name:GONZALO
Middle Name:ANTONIO
Last Name:CODINACH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 SW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3308
Mailing Address - Country:US
Mailing Address - Phone:305-262-9818
Mailing Address - Fax:305-262-8434
Practice Address - Street 1:1345 SW 87TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3308
Practice Address - Country:US
Practice Address - Phone:305-262-9818
Practice Address - Fax:305-262-8434
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 5994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22440Medicare ID - Type Unspecified