Provider Demographics
NPI:1992197677
Name:HECTOR JOSE CRESPO-GOSENDE, M.D., P.A.
Entity Type:Organization
Organization Name:HECTOR JOSE CRESPO-GOSENDE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:CRESPO-GOSENDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-551-8485
Mailing Address - Street 1:11880 SW 40TH ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3584
Mailing Address - Country:US
Mailing Address - Phone:305-551-8485
Mailing Address - Fax:305-551-8486
Practice Address - Street 1:11880 SW 40TH STREET
Practice Address - Street 2:SUITE 410
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175
Practice Address - Country:US
Practice Address - Phone:305-551-8485
Practice Address - Fax:305-551-8486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122563261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty