Provider Demographics
NPI:1518791979
Name:ADULT AND GERIATRIC PRIMARY CARE PHYSICIAN LLC
Entity type:Organization
Organization Name:ADULT AND GERIATRIC PRIMARY CARE PHYSICIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GALDAMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-799-6900
Mailing Address - Street 1:4399 N NOB HILL RD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5813
Mailing Address - Country:US
Mailing Address - Phone:954-799-6900
Mailing Address - Fax:
Practice Address - Street 1:4399 N NOB HILL RD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-5813
Practice Address - Country:US
Practice Address - Phone:954-799-6900
Practice Address - Fax:954-827-3803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty