Provider Demographics
NPI:1679002109
Name:C & V GABLES MEDICAL CENTER INC
Entity Type:Organization
Organization Name:C & V GABLES MEDICAL CENTER INC
Other - Org Name:C & V GABLES MEDICAL CENTER INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:CANOVA DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-445-5515
Mailing Address - Street 1:470 BILTMORE WAY STE 200B
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5788
Mailing Address - Country:US
Mailing Address - Phone:305-445-5515
Mailing Address - Fax:305-445-5518
Practice Address - Street 1:470 BILTMORE WAY STE 200B
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5788
Practice Address - Country:US
Practice Address - Phone:305-445-5515
Practice Address - Fax:305-445-5518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021250000Medicaid