Provider Demographics
NPI:1538677893
Name:GIL, DARIEL SR (MA)
Entity Type:Individual
Prefix:
First Name:DARIEL
Middle Name:
Last Name:GIL
Suffix:SR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 NW 178TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-3234
Mailing Address - Country:US
Mailing Address - Phone:786-515-7590
Mailing Address - Fax:786-999-8234
Practice Address - Street 1:4915 NW 178TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-3234
Practice Address - Country:US
Practice Address - Phone:786-515-7590
Practice Address - Fax:786-999-8234
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL67868225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist