Provider Demographics
NPI:1811005457
Name:FARINA, GLORIA (MD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:FARINA
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 1:370 17TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5690
Mailing Address - Country:US
Mailing Address - Phone:321-778-9991
Mailing Address - Fax:
Practice Address - Street 1:370 17TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5690
Practice Address - Country:US
Practice Address - Phone:321-778-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64921207R00000X, 207RA0000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5381Medicare ID - Type UnspecifiedGROUP
FL07024TMedicare ID - Type UnspecifiedINDIVIDUAL
FLD51837Medicare UPIN