MEDICARE: GUILLERMO BUENAVENTURA GONZALEZ LEMES

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	363LF0000X	Family Nurse Practitioner	9414641	FL

General Provider Information

NPI Number	:	1851879175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUILLERMO BUENAVENTURA GONZALEZ LEMES

Provider Business Mailing Address
First Line	:	5246 ROBBIE CT
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-9108
Country	:	US
Telephone Number	:	561-729-1148
Fax Number	:

Provider Business Practice Location Address
First Line	:	7820 N ARMENIA AVE STE C
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-3852
Country	:	US
Telephone Number	:	954-514-9360
Fax Number	:

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

Provider Enumeration Date	:	07/30/2018
Last Update Date	:	04/06/2020

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