Healthcare Provider Details

I. General information

NPI: 1265628564
Provider Name (Legal Business Name): NEUROLOGY-NEUROSURGERY OF DADE AND AIDA VERGARA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 W 20TH AVE STE 408
HIALEAH FL
33016-5533
US

IV. Provider business mailing address

6760 NW 175TH LN APT 10H
HIALEAH FL
33015-5856
US

V. Phone/Fax

Practice location:
  • Phone: 786-514-9154
  • Fax:
Mailing address:
  • Phone: 786-514-9154
  • Fax: 305-702-9441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANWAR GONZALEZ
Title or Position: PHYSICIAN
Credential: MD
Phone: 786-514-9154