Provider Demographics
NPI:1407087059
Name:GROS, EDUARDO (CHT)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:
Last Name:GROS
Suffix:
Gender:M
Credentials:CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 SW 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5737
Mailing Address - Country:US
Mailing Address - Phone:305-662-6869
Mailing Address - Fax:
Practice Address - Street 1:5121 SW 69TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5737
Practice Address - Country:US
Practice Address - Phone:305-662-6869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL419395-9OtherMIAMI-DADE COUNTY-STATE OF FLORIDA (TAX COLLECTOR)