Healthcare Provider Details

I. General information

NPI: 1568809325
Provider Name (Legal Business Name): CHRISTIAN GONZALEZ, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date: 05/04/2023
Reactivation Date: 05/18/2023

III. Provider practice location address

21097 NE 27TH CT STE 320
AVENTURA FL
33180-1206
US

IV. Provider business mailing address

PO BOX 223190
HOLLYWOOD FL
33022-3190
US

V. Phone/Fax

Practice location:
  • Phone: 305-974-5533
  • Fax: 305-974-5553
Mailing address:
  • Phone: 305-974-5533
  • Fax: 305-974-5553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIAN DAVID GONZALEZ
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 305-974-5533