Provider Demographics
NPI:1467410431
Name:PIEDRA, GLORIA MENDIZABAL
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:MENDIZABAL
Last Name:PIEDRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3986 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7000
Mailing Address - Country:US
Mailing Address - Phone:305-823-2433
Mailing Address - Fax:305-823-1727
Practice Address - Street 1:3986 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7000
Practice Address - Country:US
Practice Address - Phone:305-823-2433
Practice Address - Fax:305-823-1727
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine