Provider Demographics
NPI:1912358169
Name:DHGMSO
Entity Type:Organization
Organization Name:DHGMSO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:BASTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-816-3007
Mailing Address - Street 1:201 NW 70TH AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2369
Mailing Address - Country:US
Mailing Address - Phone:954-816-3007
Mailing Address - Fax:954-337-0146
Practice Address - Street 1:201 NW 70TH AVE
Practice Address - Street 2:SUITE D
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2369
Practice Address - Country:US
Practice Address - Phone:954-816-3007
Practice Address - Fax:954-337-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care