Provider Demographics
NPI:1821487554
Name:TRASORRAS, GLADYS BLANCA
Entity Type:Individual
Prefix:MISS
First Name:GLADYS
Middle Name:BLANCA
Last Name:TRASORRAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22841 SW 88TH PL
Mailing Address - Street 2:101
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-2055
Mailing Address - Country:US
Mailing Address - Phone:305-632-9191
Mailing Address - Fax:
Practice Address - Street 1:22841 SW 88TH PL
Practice Address - Street 2:101
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-2055
Practice Address - Country:US
Practice Address - Phone:305-632-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-8016546611-7332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies