Provider Demographics
NPI:1366853939
Name:GLOBAL HEALTH PROVIDER CORP
Entity Type:Organization
Organization Name:GLOBAL HEALTH PROVIDER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:NELIDA
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-703-4918
Mailing Address - Street 1:6001 NW 153RD ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2447
Mailing Address - Country:US
Mailing Address - Phone:786-703-4918
Mailing Address - Fax:786-703-4920
Practice Address - Street 1:6001 NW 153RD ST STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2447
Practice Address - Country:US
Practice Address - Phone:786-703-4918
Practice Address - Fax:786-703-4920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106369261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service