Provider Demographics
NPI:1346863107
Name:GAIA HOLISTIC PRIMARY CARE LLC
Entity Type:Organization
Organization Name:GAIA HOLISTIC PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBATON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-449-5448
Mailing Address - Street 1:430 STATE ROAD 436 STE 224
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-4965
Mailing Address - Country:US
Mailing Address - Phone:786-449-5448
Mailing Address - Fax:
Practice Address - Street 1:430 STATE ROAD 436 STE 224
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-4965
Practice Address - Country:US
Practice Address - Phone:786-449-5448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty