Provider Demographics
NPI:1194312165
Name:GIFT OF HEALTH MEDICAL, LLC
Entity type:Organization
Organization Name:GIFT OF HEALTH MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-728-0605
Mailing Address - Street 1:8765 SW 165TH AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5832
Mailing Address - Country:US
Mailing Address - Phone:305-728-0605
Mailing Address - Fax:786-408-5997
Practice Address - Street 1:8765 SW 165TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5832
Practice Address - Country:US
Practice Address - Phone:305-728-0605
Practice Address - Fax:786-408-5997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-24
Last Update Date:2021-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care