Provider Demographics
NPI:1790299550
Name:OSORIO, GABRIEL E (LMT)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:E
Last Name:OSORIO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14728 SW 123RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7428
Mailing Address - Country:US
Mailing Address - Phone:305-321-0258
Mailing Address - Fax:305-259-0788
Practice Address - Street 1:14728 SW 123RD AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7428
Practice Address - Country:US
Practice Address - Phone:305-321-0258
Practice Address - Fax:305-259-0788
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL682802700Medicaid