Provider Demographics
NPI:1417422288
Name:G&A PROFESSIONAL HEALTH SERVICES PLLC
Entity Type:Organization
Organization Name:G&A PROFESSIONAL HEALTH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:CUETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-934-8592
Mailing Address - Street 1:3682 N WICKHAM RD STE B1-300
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2325
Mailing Address - Country:US
Mailing Address - Phone:305-934-8592
Mailing Address - Fax:
Practice Address - Street 1:3682 N WICKHAM RD STE B1-306
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2325
Practice Address - Country:US
Practice Address - Phone:305-934-8592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLKR887OtherMEDICARE PTAN
FLDY8543OtherRRMEDICARE PTAN
FL101946200Medicaid