Provider Demographics
NPI:1407882194
Name:WOMEN'S HEALTHCARE OF PORT ST LUCIE LLC
Entity Type:Organization
Organization Name:WOMEN'S HEALTHCARE OF PORT ST LUCIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GONZALO
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-337-4600
Mailing Address - Street 1:1696 SE HILLMOOR DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7699
Mailing Address - Country:US
Mailing Address - Phone:772-337-4600
Mailing Address - Fax:772-337-7600
Practice Address - Street 1:1696 SE HILLMOOR DR
Practice Address - Street 2:SUITE A
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7699
Practice Address - Country:US
Practice Address - Phone:772-337-4600
Practice Address - Fax:772-337-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAA578OtherMEDICARE
FL77952OtherBCBSFL