Provider Demographics
NPI:1497943849
Name:CONILL, GILBERTO
Entity Type:Individual
Prefix:
First Name:GILBERTO
Middle Name:
Last Name:CONILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10873 NW 7TH ST
Mailing Address - Street 2:APT 21
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-3713
Mailing Address - Country:US
Mailing Address - Phone:305-273-9719
Mailing Address - Fax:305-273-9796
Practice Address - Street 1:9290 SW 72ND ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3236
Practice Address - Country:US
Practice Address - Phone:305-273-9719
Practice Address - Fax:305-273-9796
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43202247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other