Provider Demographics
NPI:1407953482
Name:GUALA, PABLO M (MD)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:M
Last Name:GUALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3939
Mailing Address - Country:US
Mailing Address - Phone:305-822-0668
Mailing Address - Fax:305-819-4445
Practice Address - Street 1:4811 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3939
Practice Address - Country:US
Practice Address - Phone:305-822-0068
Practice Address - Fax:305-819-4445
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97042207RC0000X, 207RI0011X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276796100Medicaid
FL276796100Medicaid