Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME66837 | FL |
NPI | 1003928292 |
---|---|
Provider Name | Gloria E Burgos |
First Address | Miami, FL 33137-3795 |
Second Address | Miami, FL 33137-3795 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 19/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
28312Y - EFF 8-31-10 | MEDICARE (01) | FL |
378912800 | (05) | FL |
G28210 | (02) |