Provider Demographics
NPI:1912302324
Name:GAVIRIA, HELENA MARIA (MD)
Entity type:Individual
Prefix:
First Name:HELENA
Middle Name:MARIA
Last Name:GAVIRIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 NW 79TH AVE STE 265
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1088
Mailing Address - Country:US
Mailing Address - Phone:786-698-5808
Mailing Address - Fax:
Practice Address - Street 1:7401 N UNIVERSITY DR STE 105
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2933
Practice Address - Country:US
Practice Address - Phone:954-589-1136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129494208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019689900Medicaid