Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | ME0045423 | FL |
NPI | 1083666325 |
---|---|
Provider Name | Gonzalo A Oria |
First Address | Port St Lucie, FL 34952-7699 |
Second Address | Port St Lucie, FL 34952-7699 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 22/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036233600 | (05) | FL |
96767 | BCBSFL (01) | FL |
96767Z | MEDICARE PROVIDER (01) | FL |
D77111 | (02) |