GUSTAVO FORTEZA MD PA
Ambulatory Health at 17 Ave, Miami, FL

License number
Florida ME85628
Category
Ambulatory Health
Type
Clinic/Center
Owner
Name: DR. GUSTAVO FORTEZA MD
Title: CEO
Phone: (305) 992-7321
Address
Address
441 SW 17Th Ave, Miami, FL 33135
National Provider ID: 1205190691
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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GUSTAVO FORTEZA, M.D., PA

Miami, FL

Industry:
Medical Doctor's Office, Business Services at Non-Commercial Site
Registration:
May 8, 2000
Addresses:
441 SW 17 Ave, Miami, FL 33135 (Physical)
13400 SW 136, Miami, FL 33186 (Mailing)
State ID:
P00000046455
Business type:
Florida Profit Corporation
President, Director:
Gustavo M.d. Forteza (President, Director), 13400 SW 136, Miami, FL 33186 (Physical)
Agent:
Gustavo Forteza,13400 SW 136 Ter, Miami, FL 33186 (Physical)
EIN:
65-1009408

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