Provider Demographics
NPI:1609215771
Name:CRESPO-GOSENDE, HECTOR JOSE (MD, PA)
Entity type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:JOSE
Last Name:CRESPO-GOSENDE
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11760 SW 40TH ST STE 606
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-8105
Mailing Address - Country:US
Mailing Address - Phone:305-564-6424
Mailing Address - Fax:
Practice Address - Street 1:11760 SW 40TH ST STE 606
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8105
Practice Address - Country:US
Practice Address - Phone:305-564-6424
Practice Address - Fax:305-564-6425
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122563207RI0011X
FLME 122563207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 122563OtherMEDICAL LICENSE