Provider Demographics
NPI:1396857926
Name:A AND A MEDICAL GROUP
Entity Type:Organization
Organization Name:A AND A MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-646-1000
Mailing Address - Street 1:1149 SW 27TH AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4758
Mailing Address - Country:US
Mailing Address - Phone:305-646-1000
Mailing Address - Fax:305-646-1656
Practice Address - Street 1:1149 SW 27TH AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4758
Practice Address - Country:US
Practice Address - Phone:305-646-1000
Practice Address - Fax:305-646-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6859208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL595400-4OtherOCCUPATIONAL LICENSE