Individual
GUSTAVO FORTEZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10550 NW 77TH CT STE 308, HIALEAH GARDENS, FL 33016-2072
(305) 863-2233
(305) 504-8813
Mailing address
10521 SW 143RD AVE, MIAMI, FL 33186-3035
(305) 889-4978
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
ME0085628
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
258912500
—
FL
01
—
29018
BLUE CROSS/ BLUE SHIELD
FL
Enumeration date
12/16/2005
Last updated
04/29/2022
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