Provider Demographics
NPI:1992183222
Name:AGVMDPA
Entity Type:Organization
Organization Name:AGVMDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ VELIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-519-9990
Mailing Address - Street 1:2150 SANS SOUCI BLVD APT 508
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-3010
Mailing Address - Country:US
Mailing Address - Phone:786-519-9990
Mailing Address - Fax:
Practice Address - Street 1:9999 NE 2ND AVE
Practice Address - Street 2:SUITE 119
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2352
Practice Address - Country:US
Practice Address - Phone:305-756-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118780174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty