MEDICARE: ADVANCHED HEALTH & WELLNESS INC

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

General Provider Information

NPI Number	:	1912185042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCHED HEALTH & WELLNESS INC

Provider Business Mailing Address
First Line	:	932 SW 82ND AVE
Second Line	:	UNIT 7
City	:	MIAMI
State	:	FL
Zip	:	33144-4240
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	932 SW 82ND AVE
Second Line	:	UNIT 7
City	:	MIAMI
State	:	FL
Zip	:	33144-4240
Country	:	US
Telephone Number	:	305-342-8692
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CARLOS GONZALEZ
Credential	:	MD
Telephone Number	:	305-342-8692

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	01/31/2008

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