| Gaia Holistic Primary Care Llc | |
|
430 State Road 436 Ste 224 Casselberry FL 32707-4965 | |
| (786) 449-5448 | |
| Not Available |
| Full Name | Gaia Holistic Primary Care Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 430 State Road 436 Ste 224, Casselberry, Florida |
| Authorized Official Name and Position | Amabel Lubaton (OWNER) |
| Authorized Official Contact | 7864495448 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gaia Holistic Primary Care Llc 430 State Road 436 Ste 224 Casselberry FL 32707-4965 Ph: (786) 449-5448 | Gaia Holistic Primary Care Llc 430 State Road 436 Ste 224 Casselberry FL 32707-4965 Ph: (786) 449-5448 |
| NPI Number | 1346863107 |
|---|---|
| Provider Enumeration Date | 05/27/2020 |
| Last Update Date | 08/04/2020 |
| Medicare PECOS PAC ID | 3678995065 |
|---|---|
| Medicare Enrollment ID | O20200611001923 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346863107 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Tima Doron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881055473 PECOS PAC ID: 0840557377 Enrollment ID: I20171207003223 |
| Provider Name | Amabel Tangunan Lubaton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093241663 PECOS PAC ID: 7012288962 Enrollment ID: I20180521000126 |
| Provider Name | Joy Tuzon Sera-josef |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336175827 PECOS PAC ID: 4183047467 Enrollment ID: I20200702002081 |
| Provider Name | Lenie Apolinario Depamaylo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427578301 PECOS PAC ID: 1153792387 Enrollment ID: I20230125001847 |
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