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Individual

GINO LAMA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
8020 W 23RD AVE STE 2, HIALEAH, FL 33016-5560
(954) 849-4292
Mailing address
8020 W 23RD AVE STE 2, HIALEAH, FL 33016-5560
(954) 849-4292

Taxonomy

Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
22091334MU
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
L500281914060
FLORIDA DRIVER LICENSE
FL
Enumeration date
02/09/2023
Last updated
02/09/2023
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