Healthcare Provider Details

I. General information

NPI: 1730523317
Provider Name (Legal Business Name): RIQUEL GONZALEZ DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4999 W 8TH AVE STE 22
HIALEAH FL
33012-3409
US

IV. Provider business mailing address

4999 W 8TH AVE STE 22
HIALEAH FL
33012-3409
US

V. Phone/Fax

Practice location:
  • Phone: 786-536-4542
  • Fax: 786-536-4484
Mailing address:
  • Phone: 786-536-4542
  • Fax: 786-536-4484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3603
License Number StateFL

VIII. Authorized Official

Name: RIQUEL GONZALEZ
Title or Position: PRESIDENT
Credential: DPM
Phone: 305-962-9089