Individual
DUSTIN GOLLOPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBA
Contact information
Practice address
22790 SW 112TH AVE, MIAMI, FL 33170-7602
(305) 235-2616
(305) 235-6178
Mailing address
22790 SW 112TH AVE, MIAMI, FL 33170-7602
(305) 235-2616
(305) 235-6178
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7665814 00
MEDICAID PROVIDER ID
FL
Enumeration date
12/21/2010
Last updated
01/24/2023
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