Provider Demographics
NPI:1760791222
Name:FORZANO, GABRIEL (DOM)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:
Last Name:FORZANO
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8433 FOREST HILLS DR
Mailing Address - Street 2:301
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5481
Mailing Address - Country:US
Mailing Address - Phone:954-755-9079
Mailing Address - Fax:
Practice Address - Street 1:8433 FOREST HILLS DR
Practice Address - Street 2:301
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5481
Practice Address - Country:US
Practice Address - Phone:954-755-9079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2889171100000X, 175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175L00000XOther Service ProvidersHomeopath