Gamma Diagnostic Lab LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

GAMMA DIAGNOSTIC LAB LLC

Practice address

2662 NW 97TH Ave
Doral, FL 33172-1400

Phone

(786) 310-7595

Fax

(786) 200-9120

NPI assigned

Mar 11, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carlos Lopez

Title

Cfo

Phone

(786) 310-7595

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583884800000",
    "number": "1780219576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2662 NW 97TH AVE",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331721400",
            "telephone_number": "786-310-7595",
            "fax_number": "786-200-9120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2662 NW 97TH AVE",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331721400",
            "telephone_number": "786-310-7595",
            "fax_number": "786-200-9120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAMMA DIAGNOSTIC LAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-11",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "786-310-7595"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "10D2178495",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gamaliel G. Mattos, MD
• Glendys Gamazo
• Jannet E Gamboa, DDS
• Nathalie Game
• Yaneidis Josefina Gamez Colmenares, FNP-C
• Melissa Garay
• Mariana Quiroz Garces
• Valeria Garcia Calixto
• Evelyn Garcia Coello
• Darlen Garcia Diaz, BCBA

• Clinical Medical Laboratory in Doral, FL
• Providers in Doral, FL by specialty
• Clinical Medical Laboratory in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.