Provider Demographics
NPI:1487052072
Name:GRACIELA C POZO MDPA
Entity type:Organization
Organization Name:GRACIELA C POZO MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:POZO
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:305-279-7275
Mailing Address - Street 1:791 CRANDON BLVD
Mailing Address - Street 2:APT 1204
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-2549
Mailing Address - Country:US
Mailing Address - Phone:305-279-7275
Mailing Address - Fax:786-219-2908
Practice Address - Street 1:791 CRANDON BLVD
Practice Address - Street 2:APT 1204
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-2549
Practice Address - Country:US
Practice Address - Phone:305-279-7275
Practice Address - Fax:786-219-2908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00389492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty