Provider Demographics
NPI:1700338555
Name:CASAS, GONZALO
Entity Type:Individual
Prefix:
First Name:GONZALO
Middle Name:
Last Name:CASAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 W FLAGLER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2470
Mailing Address - Country:US
Mailing Address - Phone:786-527-4912
Mailing Address - Fax:305-377-5438
Practice Address - Street 1:7575 W FLAGLER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2470
Practice Address - Country:US
Practice Address - Phone:786-527-4912
Practice Address - Fax:305-377-5438
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver