Provider Demographics
NPI:1689224891
Name:G.A MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:G.A MEDICAL GROUP, INC.
Other - Org Name:G.A BEHAVIORAL HEALTH GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOZADA GRANADOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-833-1225
Mailing Address - Street 1:1483 NW 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1448
Mailing Address - Country:US
Mailing Address - Phone:833-633-1225
Mailing Address - Fax:
Practice Address - Street 1:1483 NW 7TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1448
Practice Address - Country:US
Practice Address - Phone:833-633-1225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2019-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No3336C0002XSuppliersPharmacyClinic Pharmacy