Healthcare Provider Details

I. General information

NPI: 1154828135
Provider Name (Legal Business Name): WILLIAM GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 E NEW YORK AVE
DELAND FL
32724-6323
US

IV. Provider business mailing address

1424 DAYSTAR LN
DELTONA FL
32725-4728
US

V. Phone/Fax

Practice location:
  • Phone: 386-232-0449
  • Fax:
Mailing address:
  • Phone: 386-232-0449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: