Doctor Name: | MANUEL DE JESUS GAINZA |
NPI Number: | 1861442972 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | ME86679 |
Business Practice Address: | 2692 Cooper Way Wellington, FL - 334143414 |
Business Phone Number: | 5612493250 |
Business Fax Number: | |
Mailing Address: | 2692 Cooper Way, WELLINGTON |
State: | FL |
Postal Code: | 334143414 |
Phone Number: | 5612493250 |
Fax Number: | |
NPI Enumeration Date: | 05/11/2006 |
NPI Last Update Date: | 11/10/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME86679 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |