Provider Demographics
NPI:1447898218
Name:SHIMABUCO, GUSTAVO H (LPN)
Entity type:Individual
Prefix:MR
First Name:GUSTAVO
Middle Name:H
Last Name:SHIMABUCO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9734 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4004
Mailing Address - Country:US
Mailing Address - Phone:954-903-1323
Mailing Address - Fax:786-664-3342
Practice Address - Street 1:9734 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4004
Practice Address - Country:US
Practice Address - Phone:954-903-1323
Practice Address - Fax:786-664-3342
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5203997164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse