Provider Demographics
NPI:1336540699
Name:GANGERI, NATASSJA (DO)
Entity Type:Individual
Prefix:
First Name:NATASSJA
Middle Name:
Last Name:GANGERI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NATASSJA
Other - Middle Name:
Other - Last Name:FRANCES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2150 W 68TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016
Mailing Address - Country:US
Mailing Address - Phone:305-558-8700
Mailing Address - Fax:305-558-8701
Practice Address - Street 1:2150 W 68TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-558-8700
Practice Address - Fax:305-558-8701
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12928207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine