Individual
MRS. MARTHA GAVIRIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15694 NE 12TH AVE, NORTH MIAMI BEACH, FL 33162-5504
(786) 344-0490
Mailing address
15694 NE 12TH AVE, NORTH MIAMI BEACH, FL 33162-5504
(786) 344-0490
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
474085475
MEDICAID WAIVER
FL
Enumeration date
07/27/2015
Last updated
07/27/2015
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