Provider Demographics
NPI:1750326625
Name:POZO, GRACIELA CARMEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACIELA
Middle Name:CARMEN
Last Name:POZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160608
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33116-0608
Mailing Address - Country:US
Mailing Address - Phone:305-271-8394
Mailing Address - Fax:786-923-2199
Practice Address - Street 1:9090 SW 87TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2315
Practice Address - Country:US
Practice Address - Phone:305-271-8394
Practice Address - Fax:786-923-2199
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038949174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047418500Medicaid
FL047418500Medicaid
FLD63935Medicare UPIN