Provider Demographics
NPI:1356655534
Name:SOUTH FLORIDA OBSTETRICS & GYNECOLOGY, LLC
Entity Type:Organization
Organization Name:SOUTH FLORIDA OBSTETRICS & GYNECOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-556-8353
Mailing Address - Street 1:7150 W 20TH AVE STE 604
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5534
Mailing Address - Country:US
Mailing Address - Phone:305-556-8353
Mailing Address - Fax:305-827-2415
Practice Address - Street 1:7150 W 20TH AVE STE 604
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5534
Practice Address - Country:US
Practice Address - Phone:305-556-8353
Practice Address - Fax:305-827-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 35393174400000X
207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1356655534OtherNPI
FL1427027291OtherPROVIDER NPI
FL95898WMedicare UPIN