Healthcare Provider Details

I. General information

NPI: 1336672716
Provider Name (Legal Business Name): DANIEL GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4665 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2101
US

IV. Provider business mailing address

2148 W 54TH ST
HIALEAH FL
33016-2032
US

V. Phone/Fax

Practice location:
  • Phone: 786-464-0749
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberA186364
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number6061870
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberME153559
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number349189
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: