| Entity Name: | NORTH GABLES FOOT CLINIC, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 05 Nov 1993 (31 years ago) |
| Document Number: | P93000076776 |
| FEI/EIN Number | 650451389 |
| Address: | 4540 NW 7 STREET, MIAMI, FL, 33126, US |
| Mail Address: | 4540 NW 7 STREET, MIAMI, FL, 33126, US |
| ZIP code: | 33126 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629451273 | 2015-07-01 | 2015-07-01 | 4540 NW 7TH ST, MIAMI, FL, 331262307, US | 4540 NW 7TH ST, MIAMI, FL, 331262307, US | |||||||||||||||||||||||||||||||
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| Phone | +1 305-461-3448 |
Authorized person
| Name | DR. RICARDO REYES |
| Role | PRESIDENT |
| Phone | 3054613448 |
Taxonomy
| Taxonomy Code | 213ES0103X - Foot & Ankle Surgery Podiatrist |
| License Number | PO2330 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | PO2330 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN NUMBER |
| Number | 24420 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| reyes ricardo | Agent | 4540 NW 7 STREET, MIAMI, FL, 33126 |
| Name | Role | Address |
|---|---|---|
| REYES RICARDO | President | 8351 SW 85 TERRACE, MIAMI, FL, 33143 |
| Name | Role | Address |
|---|---|---|
| REYES RICARDO | Secretary | 8351 SW 85 TERRACE, MIAMI, FL, 33143 |
| Name | Role | Address |
|---|---|---|
| REYES RICARDO | Director | 8351 SW 85 TERRACE, MIAMI, FL, 33143 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
