MEDICARE: VIMAYLA E GONZALEZ M. D.

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	207Q00000X	Family Medicine Physician	ME118365	FL
2	207R00000X	Internal Medicine Physician	ME118365	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598994055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIMAYLA E GONZALEZ M. D.

Provider Business Mailing Address
First Line	:	3190 CITRUS TOWER BLVD STE B
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-6886
Country	:	US
Telephone Number	:	352-242-2282
Fax Number	:	352-242-2886

Provider Business Practice Location Address
First Line	:	3190 CITRUS TOWER BLVD STE B
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-6886
Country	:	US
Telephone Number	:	352-242-2282
Fax Number	:	352-242-2886

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

Provider Enumeration Date	:	07/06/2009
Last Update Date	:	05/25/2023

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