MEDICARE: HECTOR GONZALEZ

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	171M00000X	Case Manager/Care Coordinator	CBHCM104048	FL

General Provider Information

NPI Number	:	1396486031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HECTOR GONZALEZ

Provider Business Mailing Address
First Line	:	8268 NW 24TH ST
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-5667
Country	:	US
Telephone Number	:	786-443-0030
Fax Number	:

Provider Business Practice Location Address
First Line	:	8268 NW 24TH ST
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-5667
Country	:	US
Telephone Number	:	786-443-0030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2022
Last Update Date	:	04/06/2022

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Directions to “ HECTOR GONZALEZ ” Practice Location

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