Healthcare Provider Details

I. General information

NPI: 1760648315
Provider Name (Legal Business Name): GONZALO N. GUTIERREZ BORGES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GONZALO NICANOR GUTIERREZ BORGES MD

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 CORAL HILLS DR STE 360
CORAL SPRINGS FL
33065-4172
US

IV. Provider business mailing address

8400 NW 33RD ST FL 33122
DORAL FL
33122-2008
US

V. Phone/Fax

Practice location:
  • Phone: 844-665-4872
  • Fax:
Mailing address:
  • Phone: 305-470-2943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME166236
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number19712
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: