MEDICARE: GONZALO J IRAVEDRA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME32736	FL

General Provider Information

NPI Number	:	1215941596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GONZALO J IRAVEDRA PA

Provider Business Mailing Address
First Line	:	18503 PINES BLVD
Second Line	:	SUITE 303
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-1404
Country	:	US
Telephone Number	:	954-499-7878
Fax Number	:	954-499-7877

Provider Business Practice Location Address
First Line	:	18503 PINES BLVD
Second Line	:	SUITE 303
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-1404
Country	:	US
Telephone Number	:	954-499-7878
Fax Number	:	954-499-7877

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GONZALO J IRAVEDRA
Credential	:	MD
Telephone Number	:	954-499-7878

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	06/19/2008

Similar Medicare Providers

1336401538 — DR. MAGDALEINA V JOSEPH PHD, AAPRN, FNP-BC
Practice Location Address:

18503 PINES BLVD
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33029-1404

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1881655157 — DEAN PALMER M.D.
Practice Location Address:

18503 PINES BLVD , SUITE 311
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1487769683 — ACADIA NEURO-BEHAVIORAL ASSOCIATES PA
Practice Location Address:

18503 PINES BLVD , SUITE 214
PEMBROKE PINES, FL
33029-1404

Practice Phone: 954-432-3800
Practice Fax: 866-404-8639

1164585238 — DR. ROBIN EUGENE GIPPS LMFT
Practice Location Address:

18503 PINES BLVD , SUITE 214
PEMBROKE PINES, FL
33029-1404

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1245387588 — ATRIA DENTAL HEALTH CENTER, P.A.
Practice Location Address:

18503 PINES BLVD , SUITE 208
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1396899316 — MRS. MARIA MEZCUA D.D.S. P.A.
Practice Location Address:

18503 PINES BLVD , SUITE # 202
PEMBROKE PINES, FL
33029-1404

Practice Phone: 954-432-4101
Practice Fax: 954-432-5330

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