Provider Demographics
NPI:1750984126
Name:CARVAJAL GONZALEZ, GABRIELYS
Entity type:Individual
Prefix:
First Name:GABRIELYS
Middle Name:
Last Name:CARVAJAL GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 NW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1867
Mailing Address - Country:US
Mailing Address - Phone:305-477-0184
Mailing Address - Fax:
Practice Address - Street 1:10701 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-1867
Practice Address - Country:US
Practice Address - Phone:305-477-0184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist