Provider Demographics
NPI:1710684832
Name:LAMA, GINO
Entity Type:Individual
Prefix:
First Name:GINO
Middle Name:
Last Name:LAMA
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 1:8020 W 23RD AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5560
Mailing Address - Country:US
Mailing Address - Phone:954-849-4292
Mailing Address - Fax:
Practice Address - Street 1:8020 W 23RD AVE STE 2
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5560
Practice Address - Country:US
Practice Address - Phone:954-849-4292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22091334MU247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL500281914060OtherFLORIDA DRIVER LICENSE