Healthcare Provider Details

I. General information

NPI: 1487496451
Provider Name (Legal Business Name): JOEL D GONZALEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W 20TH AVE STE G176
HIALEAH FL
33016-1875
US

IV. Provider business mailing address

2001 W 68TH ST
HIALEAH FL
33016-1801
US

V. Phone/Fax

Practice location:
  • Phone: 786-475-1985
  • Fax: 786-475-2854
Mailing address:
  • Phone: 786-860-6004
  • Fax: 305-441-9342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9119315
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: