Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 9242082 | FL |
NPI | 1003331273 |
---|---|
Provider Name | Gilberto J Avila Rodriguez |
First Address | Miami, FL 33184-2704 |
Second Address | Miami, FL 33184-2704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2017 |
Last Update Date | 09/08/2017 |