Provider Demographics
NPI:1013243849
Name:CENTRO MEDICO FAMILIAR BUEN PASTOR INC
Entity Type:Organization
Organization Name:CENTRO MEDICO FAMILIAR BUEN PASTOR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-882-0191
Mailing Address - Street 1:4440 SHERIDAN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3535
Mailing Address - Country:US
Mailing Address - Phone:954-882-0191
Mailing Address - Fax:954-963-1557
Practice Address - Street 1:4440 SHERIDAN ST
Practice Address - Street 2:SUITE C
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3535
Practice Address - Country:US
Practice Address - Phone:954-882-0191
Practice Address - Fax:954-963-1557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001771300Medicaid