Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN 13904 | FL |
NPI | 1477992550 |
---|---|
Provider Name | Dr. Cristino J Gavarrete |
First Address | Miami, FL 33194-2700 |
Second Address | Miami, FL 33194-2700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2013 |
Last Update Date | 21/06/2013 |