Provider Demographics
NPI:1811448111
Name:PUERTA GARCIA, OSMANY
Entity type:Individual
Prefix:
First Name:OSMANY
Middle Name:
Last Name:PUERTA GARCIA
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 1:1035 SW 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4907
Mailing Address - Country:US
Mailing Address - Phone:305-305-5197
Mailing Address - Fax:
Practice Address - Street 1:1035 SW 62ND AVE
Practice Address - Street 2:
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4907
Practice Address - Country:US
Practice Address - Phone:305-220-3600
Practice Address - Fax:305-220-8191
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9297863363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily