Healthcare Provider Details

I. General information

NPI: 1851965784
Provider Name (Legal Business Name): STEPHANIE M GONZALEZ SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2021
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 E GRAND HWY
CLERMONT FL
34711-3708
US

IV. Provider business mailing address

735 AVE DE LA CONSTITUCION
SAN JUAN PR
00917
US

V. Phone/Fax

Practice location:
  • Phone: 352-557-4965
  • Fax:
Mailing address:
  • Phone: 787-758-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number176805
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23195
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: